Applicant Applicant Name* First Last Applicant Email* Applicant Phone*Date of Birth* Date Format: MM slash DD slash YYYY GenderMaleFemaleAn identity not listed aboveAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CountyRetired?*YesNoIf so, When? MM DD YYYY If not, do you plan to retire soon?For how many years do you consider yourself retired from full-time work?From what industry?What organizations do you currently volunteer with, if any?Highest level of education completedDoctoral DegreeMaster's DegreeBachelor's DegreeAssociate's DegreeSome CollegeHigh SchoolPhysical LimitationsDietary RestrictionsAreas of interest for volunteering Select All Administrative/office functions Advocacy and human rights Animals Arts and culture Board service Children and youth Computers and technology Crisis support Disabled Education and literacy Employment Faith-based Health and medicine Homeless and housing Hunger Immigrants and refugees Outdoor work Poverty and basic needs Seniors Special events Victims' services Are you applying to participate with a friend or friends? If so, please indicate name(s).Class(es) Applying For – Check all of interest* Class 14(virtual): February 10-11; 17-18, 2021 Class 15 (virtual): April 28-29, March 5-6, 2021 Class AssignedFormat =0014Do you know someone who might also be interested in the Give 5 program? If so, please let us know and we'll reach out to them!Name First Last PhoneEmail How Did You Hear About Us?*RadioTelevisionHeard It From A FriendFacebook / Social MediaNewspaperPresentationThank you for applying! A coordinator will be in touch with you soon. Give 5 is brought to Springfield-Greene County by United Way of the Ozarks and is funded by the Greene County Senior Citizens' Service Fund, private donors and sponsoring organizations. Presenting sponsor is UnitedHealthcare. Gold-level sponsor is Arvest Foundation. Silver-level sponsors are BKD Wealth Advisors and Heim-Young & Associates Wealth Management and Doe’s Eat Place. Mattax Neu Prater Eye Center is a bronze-level sponsor. When would you be interested in participating in the program?Orig Referrer
