Rising Stars

Name: Address: Postal Code: Telephone: May we call you at work? Home: Work: Yes Email:

No

Education: Briefly summarize your educational training

Previous Volunteer Experience: (Please list from most recent) Agency: Telephone: Volunteer Duties:

If you have extensive volunteer experience, please summarize:

Employment History: Are you currently employed? Yes Employers Name: Address: Telephone: Current Responsibilities: List your special skills, hobbies or interests:

No

Rising Stars
Please list groups/organizations with which you are affiliated

Additional Comments:

Signature:

Date:

Please drop off at the Chamber of Commerce (#170-110-1st Avenue West) or Fax to 250- 624-6105 Thank you for your interest in this program!