Volunteer Application

You can also print this form, fill it out, and mail or fax it to the Ele’s Place nearest you.

355 S. Zeeb Road, Suite E, Ann Arbor, MI 48103 fax (734) 926-0985

1145 W. Oakland Ave., Lansing, MI 48915 fax (517) 482-6608

If you have any questions or have not heard back from a volunteer coordinator, please contact:

Ann Arbor Location: Leela Kausch at 734-929-6640 or lkausch@elesplace.org

Lansing Location: Gillian Maynard at 517-482-1315 or gmaynard@elesplace.org

Which Ele's Place location are you interested in: *

Name (First & Last): *

Email Address: *

Street Address: *

City: *

State: *

ZIP Code: *

Age (if under 19):

Home Phone Number: *

Work Phone Number:

Cell Phone Number:

Employer:

Why are you interested in volunteering with Ele's Place?: *

What type of volunteer work are you interested in? (check all that apply)

Other Volunteer Opportunities:

Serving as an Outreach Ambassador

Delivering Brochures (as assigned)

Assisting with Fund-Raising Events

Assisting in the Office

Assisting with Garden Care

If you are not interested in working directly with Ele's Place support group program, you may skip this section

Describe your experience in working with children:

Describe any experience you have had with the death of a family member or close friend:

Do you have clinical certifications or degrees (MSW, LLP, LMSW or similar)?:

Yes

If yes, please describe:

Have you ever been convicted of any felonies or misdemeanors (other than for a minor traffic offense):

Yes

If yes, please describe:

Organization:

Type of Work:

Supervisor:

Dates:

I agree to the terms below

I give permission to Ele’s Place to contact my volunteer supervisor(s) and I release my supervisor(s) from any liability for supplying information about my performance and suitability as a volunteer.

Lansing Location	Ann Arbor Location
p: 517.482.1315	p: 734.929.6640
f: 517.482.6608	f: 734.926.0985
1145 W. Oakland Ave	355 S. Zeeb Rd., Suite E
Lansing, MI 48915	Ann Arbor, MI 48103
contact us	contact us

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