Volunteer Interest Form Volunteer Interest Form Please fill out the following interest form. Name(Required) First Last Address Street Address Address Line 2 City State ZIP / Postal Code Date of BirthPersonal PronounsPhone 1(Required)Phone 2Email(Required) Enter Email Confirm Email Emergency Contact Information First and Last Name(Required)Relationship(Required)Address(Required)Phone(Required)How you hear about BIAV?(Required)Please let us know why you are interested in volunteering for BIAV(Required)Have you volunteered anywhere in the past? If so, in what capacity?(Required)Do you have any special skills or qualifications from work or volunteer experiences?(Required)Are there any tasks or work that you would not be able to perform?(Required) Yes No If yes, please explain.Do you require any accommodations?(Required) Yes No If yes, please explain.If you speak any languages other than English, please list.What are your areas of interest?(Required) Information and Referral: mailing, update resource lists, clerical Advocacy: legislative day assistance, write or call legislators Education: help with annual conference, webinars Support Groups: help with special events, leader training, panels Technology Support: Microsoft Office/Excel, Adobe, website admin Special Events: fundraising, health fairs, outreach booths Camp Bruce McCoy: help with various camp activities, supply coordination Advisory Groups: provide information on trends, share information on community needs Speaker’s Bureau: participate in a speaking engagement What is your availability? Please list days and if you are available mornings, afternoons, or evenings.(Required)Are you fulfilling community service hours?(Required) Yes No Do you require written documentation of hours?(Required) Yes No Do you have any criminal convictions (other than traffic violations or minor juvenile offenses)?(Required) Yes No If yes, please explain.Thank you for your interest in volunteering for the Brain Injury Association of Virginia. Someone will contact you shortly.BIAV is an equal opportunity organization and will not allow discrimination based upon age, ethnicity, ancestry, gender, national origin, disability, race, size, religion, sexual orientation, socioeconomic background, or any other status prohibited by applicable law. Δ