Volunteer

Data Form

Please copy and send to us this form designed to help both CMUS and you derive the greatest benefit from your willingness to serve as a volunteer. As much as possible, CMUS wants to be able to match your interest, skills and availability with the many ways you can help CMUS serve our community. Information about your mediation-related training and experience, as well as other volunteer activities, will enable CMUS to develop and maintain an automated database that will help you stay connected to CMUS. Should any of the information on this form change, please notify CMUS.

Date Completed _______________

Name:______________________________________________________________________ Address: _____________________________________________________________________ Phone: (h)_____________________ (w)_____________________ (c)___________________ Email: ______________________________________________________________________ Gender:_____________ Birth Date:________________ Race/Ethnicity:__________________ Gender, race and age information is optional and will only be used for grant reporting. Languages and proficiency: ______________________________________________________ How did you become aware of CMUS: ______________________________________________ _____________________________________________________________________________ Why are you interested in becoming a volunteer with CMUS? ___________________________ _____________________________________________________________________________ _____________________________________________________________________________ When are you available for volunteering at CMUS? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Morning ______ ______ ______ _______ ______ ______ _______ Afternoon ______ ______ ______ _______ ______ ______ _______ Evening ______ ______ ______ _______ ______ ______ _______ Where are you able to mediate? Cecil County Kent County Queen Anne's County Comments: ___________________________________________________________________ _____________________________________________________________________________ Mediation related training through Community Mediation Maryland: Basic Mediation I ___________ Intake ___________ Basic Mediation II ___________ Parent/Teen ___________ Community Outreach ___________ Parenting ___________ Community Solutions ___________ Speaker’s Bureau _______ IEP Facilitation ___________ Other _________________ Experience and other mediation training: ___________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Check all volunteer opportunities at CMUS that interest you and briefly describe your experience. Items with asterisk require training. Bookkeeping _________________________________________________________________ Bulk Mailing _________________________________________________________________ Community Outreach ___________________________________________________________ Computer Assistance ___________________________________________________________ Fundraising _________________________________________________________________ Grant Writing _________________________________________________________________ Intake* _________________________________________________________________ Mediator* _________________________________________________________________ Newsletter _________________________________________________________________ Speaker’s Bureau* ____________________________________________________________ Training Assistance ____________________________________________________________ Word Processing ____________________________________________________________ Please list any other organizations/groups/causes/etc. in which you are involved: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Level of formal education: ________________________________________________________ Thank you for your time and future contributions to CMUS. We look forward to working together to bring peace to our community.