Disaster Volunteer Request Form

10221 Wincopin Circle, Columbia, MD 21044 • Phone 410.715.3172
Fax 410.715.0845 • www.volunteerhoward.org • info@volunteerhoward.org

The Volunteer Center Serving Howard County does not discriminate on the basis of age, sex, race, color, religion, national origin, disability, marital status, sexual orientation, or political affiliation.

The Volunteer Center Serving Howard County provides volunteer recruitment and referral services to non-profit agencies. The Volunteer Center does not pre-select or guarantee placement with any agency. Potential volunteers are referred to positions based on their specific interests, skills, and availabilities, but may be required to comply with any and all regulations and requirements of the agency utilizing the volunteer's services. The Volunteer Center will work with volunteers to find appropriate referrals, but there may be times when none can be made. Volunteers may decline to work for an agency.

Agency Information
Agency Name:
Contact Name and Title:
Contact Phone:
Contact Fax:
Contact Cell:
Contact E-mail:
Are you currently registered with the Volunteer Center Serving Howard County: (Please note, your agency must* be registered with the Volunteer Center in order to submit a request -Click here for general registration)*	Yes No

Volunteer Request Information
Volunteers Requested:	Adults Youth, minimum age
Volunteer Duties:
Number of Volunteers Needed:	Minimum Maximum
Hours/Days Requested:
Expected Duration of Project:
Location :
Site Contact Name:
Site Contact Phone:
Site Contact E-mail:
Preferred Mode of Initial Volunteer Contact: (cell phone, office phone, e-mail, go to site, etc.)
Special skills requested:
Special instructions,clothing, eqipment, or other necessities:
Directions to site: (if possible, please provide geographical landmarks in case road signs are obstructed)

Request Submitted By:
Name:
Title:
Date:




10221 Wincopin Circle, Columbia, MD 21044 • Phone 410.715.3172 Fax 410.715.0845 • www.volunteerhoward.org • info@volunteerhoward.org The Volunteer Center Serving Howard County does not discriminate on the basis of age, sex, race, color, religion, national origin, disability, marital status, sexual orientation, or political affiliation. The Volunteer Center Serving Howard County provides volunteer recruitment and referral services to non-profit agencies. The Volunteer Center does not pre-select or guarantee placement with any agency. Potential volunteers are referred to positions based on their specific interests, skills, and availabilities, but may be required to comply with any and all regulations and requirements of the agency utilizing the volunteer's services. The Volunteer Center will work with volunteers to find appropriate referrals, but there may be times when none can be made. Volunteers may decline to work for an agency.