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VOLUNTEER SERVICE APPLICATION—NATURAL & CULTURAL RESOURCES
The volunteer application helps public lands officials and potential volunteers determine if there are volunteer opportunities that are a good match for the skills and interests identified. All volunteers are required to complete a volunteer agreement once they have identified and committed to a specific volunteer activity.  Mark  in the appropriate boxes and print or type all responses.
1.    Name (Last, First, Middle)
            
2. Age
   
3. Telephone Number
      (   )     -     
4. Email Address
     
5.   Street Address, Apt. #
           
6.  City, State, and Zip Code
     
7.   Which general categories are you most interested in volunteering?  Check all that apply.
    Archaeology
    Botany
    Campground/Site host
    Campground maintenance
    Construction maintenance
    Computers
    Conservation education

  GIS/GPS
  Fish/Wildlife
  Historical/Preservation
  Pest/Disease control
  Minerals/Geology
  Natural resources planning
  Office/Clerical
  Range/Livestock

  Research/Librarian
  Soil/Watershed
  Timber/Fire prevention
  Trail maintenance
  Tour guide/Interpretation
  Visitor information
  Other (Please specify)      

8.  What qualifications, skills, or experiences do you have that you would like to use as a volunteer?  Check all that apply.
   Backpacking/Camping
   Biology
   Boat operation
   Carpentry
   Clerical/Office machines
   Computer programming
   Drafting/Graphics
   Driver’s license
   First aid certificate

  Hand/Power tools
  Heavy equipment operation
  Horses – care/ riding
  Landscaping/Reforestation
  Land surveying                                                Livestock/Ranching
  Map reading or GIS/GPS
  Mountaineering
  Photography

  Public speaking
  Research/Librarian
  Sign language
  Supervision
  Other trade skills (Please specify)     
  Teaching
  Working with people
  Writing/Editing
  Other (Please specify)      

9.  If you have a specific volunteer interest, please identify and describe your qualifications, skills, experiences, or education that may apply.

    10. Are you a United States Citizen?        Yes       No  (If no, additional information may be required)
    11. a. Have you volunteered before?        Yes       No
b. If yes, please list the organization where you volunteered with a contact name and phone # or email address, and briefly describe what you did.       


    12. Would you like to supervise other volunteers?       Yes       No
    13. What are some of your objectives for volunteering? (Optional)       




    14. Please list any physical limitations that may impact your volunteer activities.
     
    15. a. Which months are you available to volunteer? Check all that apply.
  January
  July
  February
  August
  March                    September
  April
  October
  May
  November
  June
  December
15b. How many hours per week would you be available for volunteer work?   Hours    
15c. Which days are you available to volunteer? Check all that apply.
   Monday           Tuesday          Wednesday          Thursday           Friday          Saturday          Sunday
    16. Specify states or locations where you would like to volunteer.
     

    17. Specify your lodging needs:
   I will furnish my own lodging (such as tent; camper; own, relative’s, or friend’s place)
   I will require assistance in finding lodging
    18. If a volunteer assignment is not available at the location specified in box #16, do you want your application forwarded to another location or Federal agency seeking volunteers with your background or interests?
   Yes        No  (Please specify)       
    19. How did you hear about this volunteer opportunity?  Check all that apply.
  Volunteer.gov
  Brochure
  Other internet or website
  Volunteer fair or event
  Advertisement
  Other (Specify)
  Word of mouth (friend, colleague, family member)



Public Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0080. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  USDA, DOI, DOC and DOD prohibit discrimination in all programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. Not all prohibited bases apply to all programs.
Notice to Volunteer
Volunteers are not considered Federal employees for any purposes other than tort claims and injury compensation. Volunteer service is not creditable for leave accrual or any other benefit. However, volunteer service is creditable work experience. By signing this application the volunteer(s) understand(s) s/he may be subject to a reference check, background check, and/or criminal history inquiry.
Privacy Act Statement
Collection and use is covered by Privacy Act System of Records OPM/GOVT-1 and USDA/OP-1, and is consistent with the provisions of 5 USC 552a (Privacy Act of 1974), which authorizes acceptance of the information requested on this form.  The data will be used to maintain official records of volunteers of the USDA and USDI for the purposes of tort claims and injury compensation.  Furnishing this data is voluntary, however if this form is incomplete, enrollment in the program cannot proceed.
    20. Signature

21.  Date