Volunteer Form

Contact Information

First name*

Last name*

Phone number*

Email*

Date of birth*

Select County of Volunteering*

please select one county

Church Name/Affiliation*

Senior Pastor's Name*

Church Leader Reference Name & Contact Information

please provide one church leader name and contact information for volunteer reference

Volunteer Roles/Areas of Interest

We have many different ways for you to volunteer here at 111Project! A few are listed below. Please check all that interest you!*

Community Coordinator

Church Ambassador

Facilitate Community Gatherings

Recruit Donors/Community Champions

Advocate for Careportal Requests

Local Story Telling/Press Releases

Facilitate Church Training

Event Volunteer

Please enter any other offices or general activities in which you are interested in participating:

In considering service with 111Project, what attracts you to the mission of 111Project. Please summarize any experience with 111Project or like organization(s) and indicate your level of understanding and commitment to our mission.*

Organizational Agreements

Do you agree with 111Project's statement of faith? *

Statement of Faith

Yes

Do you agree with our policies on nondiscrimination, harassment, sexual harassment, conflict of interest, and whistle blower protection?*

111Project Policies

Yes

Please Upload a Picture of Yourself for Website and Promotional Use. 10MB file size limit. *

Bio Information - Please include a short bio description of yourself to be used potentially for Website and Promotional Uses. 3-4 sentences about yourself, career, family, or pertinent information to 111Project churches and partners.

T-Shirt Size*

2XL

3XL

Facebook URL

Do you have any food allergies?

Favorite Snacks (Food and Drink)

If you were to receive a gift card, what merchant would you prefer?