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Contact Information

Name*
Email Address*
Street Address*
City/Town*
State*
Zip Code*
Home Phone Number*
Cell Phone Number
Work Phone Number
Preferred Method of Contact*
1. Email
2. Home Phone
3. Cell Phone
4. Work Phone
Preferred Contact Time*
1. AM
2. PM
Date of Birth*
Additional Details
Important medical information, physical limitations, other emergency contacts, etc.
Emergency Contact Name*
Contact Phone*
Relationship*
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Education*
List institutions, diplomas, certificates, degrees, etc.
Interests/Skills/Hobbies*
Current/Most Recent Employment*
Prior Volunteer Experience*
Describe experience, include organization names and dates of service.
Do you have a car available for use?*
1. Yes
1. No
If you speak other languages, list here:
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Days and Times of Availability
Most volunteer needs are during COA business hours (Monday to Friday 9:00am to 4:00pm); weekend volunteer needs are occasional.
I prefer to work:*
1. Regular Schedule
2. Intermittently
1. Other
If other, describe:*
Fill out the times you are available in the fields below. Most volunteer needs are during COA business hours (Monday to Friday 9:00am to 4:00pm); weekend volunteer needs are occasional.
Monday From:
Monday To:
Tuesday From:
Tuesday To:
Wednesday From:
Wednesday To:
Thursday From:
Thursday To:
Friday From:
Friday To:
Saturday From:
Saturday To:
Sunday From:
Sunday To:
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References
Please list two people who know you well and can attest to your character, skills, and dependability. Please do not include family members.
Contact 1
Name & Organization*
Relationship*
Length of Relationship*
Phone Number*
Email Address*
Contact 2
Name & Organization*
Relationship*
Length of Relationship*
Phone Number*
Email Address*
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The Council on Aging is open from 9:00am to 4:00pm Monday through Friday. Applicants will be required to provide a valid driver's license, or other acceptable photo ID, and complete a CORI Request form before beginning any volunteer engagement.
For questions, contact:
Sally Miller, Volunteer Coordinator
Wellesley Council on Aging
500 Washington Street, Wellesley, MA 02482
Email: smiller@wellesleyma.gov
Phone: (781) 235-3961
Your electronic signature below indicates your agreement with the following statement: By typing my name in the following box and clicking submit button I certify the above statements to be true and correct, to the best of my knowledge.
Applicant Signature*

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