Form Center

2. Date*
   Date
4. Have you been convicted of a felony?*

   1. Yes
   2. No
6. Name*
7. Email Address*
9. Physical Address*
11. PO Box Address / Route Number
13. City*
14. State*
15. Zip Code*
17. Primary Number*
18. Secondary Number
20. Date of Birth*
    Date of Birth

    For Placement purposes only.

21. Volunteer Selection*
    -- Select One --AdministrationCity Boards and CommissionsPublic WorksCommunity & Economic DevelopmentMarshall Police DepartmentMarshall Fire DepartmentSupport ServicesTourism & Cultural Arts Department

    Department Choices

22. Days Available To Volunteer*

    1. Sunday
    2. Monday
    3. Tuesday
    4. Wednesday
    5. Thursday
    6. Friday
    7. Saturday
23. Preferred Hours*
    Preferred Hours Start Time

    —

    Preferred Hours End Time
25. Fluent Languages Other Than English
27. Physical Limitations*
29. Emergency Contact Name*
31. Emergency Contact Phone*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit Submit and Print

* indicates a required field