PERSONAL INFORMATION
Name:
Spouse:
BUSINESS INFORMATION
Employer:
Title/Position:
BUSINESS ADDRESS
Street:
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Zip Code:
Phone:
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E-Mail:
Assistant Name:
Assistant Phone:
Assistant E-Mail:
HOME ADDRESS
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City:
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Zip Code:
Phone:
Cell Phone:
Fax:
E-Mail:
CONTACT PREFERENCE
Please contact me at:	Home   Work
PROFESSIONAL EXPERTISE (please check all that apply)
Accounting Communications/Media Community Development Computer/Information Technology Education Financial Management Fund Raising/Development Government Health Services Human Resources Human Services Labor Legal Management Sales/Marketing Training and Development If other, please specify:
VOLUNTEER POSITIONS and CORPORATE DIRECTORSHIPS
Please list current and past positions held with nonprofit organizations (excluding United Way), foundations, educational institutions, government affiliations, and corporate directorships.
Organization Position Period (from/to)
VOLUNTEER INTEREST (please check all that are of interest)
Administration AIDS Education/Employment Family and Children Finance Fund Raising Government Relations Health/Medical Homelessness Human Resources Information Technology Literacy Marketing Mental Health Planning/Fund Distribution Seniors/Older Adults Youth
If other, please specify:
EDUCATIONAL BACKGROUND
School Degree Year Graduated
DEMOGRAPHIC DATA
This confidential data will be used to compile a demographic profile of United Way's volunteers. This information is to insure that United Way's volunteers are representative of all categories of gender, race, age, and religion. This data will also aid our future recruitment efforts.
Gender:   Female    Male
Date of Birth (month/day/year):     /    /
Race: African American Asian Caucasian Hispanic
If other, please specify:
Religion: Catholic Jewish Muslim Protestant
If other, please specify: