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Volunteer Application

Date of Application:

Name:
Last First

Address:
Street City PIN/ZIP

Street

Country

Telephone: E-mail: Nationality: Languages spoken: Area(s) of interest: (please mark all that apply)

Mobile/cell, if available: Date of Birth: Profession:

[Note: see http://www.autism-india.org/volunteer_positions.html for a description of the Options 1-9]

___Option 1: Speech/language pathologist ___Option 2: Music assistant ___Option 3: Arts & crafts assistant ___Option 4: Day care assistant ___Option 5: Classroom assistant ___Option 6: School assistant ___Option 7: Activity based assistant ___Option 8: Event-based assistant ___Option 9: Fundraising assistant ___other (please describe below):

___Being a buddy for a teen/adolescent ___Autism Network/Journal ___Website ___Administrative and clerical work

What are you hoping to gain from your volunteer experience with Action for Autism?

Do you have any experience with people with autism? Please describe below.

When and for how long would you like to visit the organization?

How did you hear about Action for Autism?

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