Volunteer and/or Placement Application Form for

Autism Ontario Sarnia/Lambton

Name:             _____________________________________________

Address:          _____________________________________________

                        _____________________________________________

                        _____________________________________________

Phone (home):__________________________ (other):__________________________

Email:             ______________________________________________

Volunteer Experience in any other organization:  _____________________________________________

_____________________________________________

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Do you have a valid Ontario Driver’s License?       _________________

Do you have a vehicle available to you?      _________________

References - Please provide two reference names with address and contact number.

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Volunteer Availability and Areas of Interest

I wish to volunteer for:

______ A limited time (i.e. specific # of hours, season, etc.) explain: ____________

______ Ongoing basis

I have decided to volunteer my time at Autism Ontario because

Please check all that apply.

________ In need community services hours.  For which school? ________________

________ I need a Co-op placement

________ To develop good references

________ To participate in social activity and/or meet people

________ To gain specific skills (i.e. fundraising, work with children with ASD)

________ I wish to donate my time and skills

________ Other __________________________________________________________

I am interested in the following type(s) of position(s): 

Please check all that apply.

______ Family/social event planning

______ Family/social event assistance

______ Workshop/training event planning

______ Workshop/training event assistance

______ Fundraising activities planning

______ Fundraising activities assistance

______ Public relations/marketing

______ Social skills program planning

______ Social skills program assistance

______ Summer camps preparation

______ Summer camps assistance

______ General office work (computer,
              photocopying, reception, etc.)

______ Other _________________________