Promoting Ethical Profits and Responsible Commerce

Volunteer Application

First Name
Last Name
Middle Initial
Date of Birth
Street Address
Address (cont.)
City
State
Zip
Home Phone
Work Phone
Other Phone
Email
How may we contact you?	Yes, mail is OK Newsletter only No mail, please Phone calls OK at home or office Office only Home only No calls
Contact Preference	Phone    Email    Mail    No preference
Education/ Experience	Highest grade/level completed: Are you currently a student? If yes, what is your course of study? Please list any other experience/training you would like us to know about:
Employment	Please check the box that best describes your employment:   Currently employed (full-time) Currently employed (part-time)   Employer: Retired Unemployed Disabled Other
Language	What is your primary language? English Spanish French German Italian Portuguese Chinese Japanese Other American Sign Language   English: Read Write  Speak: Fluent Conversational Basic Spanish: Read Write  Speak: Fluent Conversational Basic : Read Write  Speak: Fluent Conversational Basic
Transportation	What form of transportation do you use? Car Truck Public Transit Other (specify):  Do you have a valid Arizona driver's license?  Yes No No, my license is from another state:  Do you have current automobile insurance? Yes No Not applicable
Volunteer Interests	Please check all volunteer positions that would be of interest to you: Data Entry/Filing Research Outreach Fundraising Advocacy Public Speaking Newsletter/Mailings Special Events Not sure yet
Other/Special Interests	Do you have some special skills or talents that you would like to share?  Please describe:   Have you volunteered with SCEI in the past? Yes No Not sure If yes, when did you last volunteer, and what was your position?    Have you volunteered with another agency or oganization in the past? Yes No Not sure If yes, when did you last volunteer, and what was your position?
References	Please provide us with 1 personal and 1professional reference.   1. Name:   Daytime Phone:     Relationship:   Email:   2. Name:  Daytime Phone:     Relationship:  Email:
Demographic Information	Please take a few moments to complete the following information.  Though it is not required, tracking this information can be very helpful for funding purposes.  This information will be kept confidential.  Please feel free to ask questions as needed.  Please check the most appropriate box:   Sex/Gender: Male Female                    Other:   Ethnicity/Race: (check all that apply) Black/African American Hispanic/Latino Native American/Alaskan Native Asian            Native Hawaiian/Other Pacific Islander                          White/Caucasian Other:     How many family members are currently living in your household (including yourself)? Please check the box that represents your combined family income (includes income for all adults): $0 to $9,999 $10,000 to $19,999 $20,000 to $29,999  $30,000 to $39,999 $40,000 to $49,999 $50,000 or more

Please note: If clicking on the Submit Form button results in an error, you may print this form, complete it, and mail or fax it to:

Southwest Center for Economic Integrity
P. O. Box 41972
Tucson, AZ 85717-1972
Fax: 520-743-9110