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Museum Volunteer page
BURPEE MUSEUM OF NATURAL HISTORY
VOLUNTEER AND INTERN APPLICATION
INSTRUCTIONS: Use your browser's "PRINT" button to
print this page -- use a "portrait" orientation and half-inch margins top,
bottom, right, left. There are two pages.
Please return the form to the Front Desk at Burpee Museum, or mail it to:
Burpee Museum, Attn: Volunteer Coordinator
737 North Main Street
Rockford, IL 61103
The following information will help the museum
evaluate prospective volunteers and interns and match them with meaningful
positions.
All information provided is confidential.
Placement will will made after interviews
with the Volunteer Coordinator and a prospective supervisor have been conducted.
* Answers to
asterisked questions are not required; your answers help us determine the
diversity of our staff.
| Date of Application: |
| Name: |
| Address:
City:
State:
Zip: |
| Home Phone:
Business Phone:
Email: |
| *Date of Birth:
*Sex: __ Male __Female
*Social Security Number |
*Ethnic Origin:
__African-American __Asian
__Caucasian __Latino
__Multi-ethnic Other: |
| Foreign Language or Hobbies:
|
| Are you a member of the Burpee? How did you
hear about our volunteer program?
|
Emergency Contact Name:
Relationship:
Home Phone:
Business Phone: |
| Have you ever been convicted of a crime?
If yes, please indicate the nature of the crime, and time served:
|
| Please list any medical restrictions, allergies, or
requirements that may effect your volunteer / intern work.
|
| EDUCATIONAL DATA |
Name and Location of Institution |
Major or Field of Study |
| High School |
|
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| College or University |
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| Graduate School |
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| Trade School or Special Training |
|
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| Current Employer's Name: |
| Position/Title:
Start Date: |
| Supervisor's Name and Title: |
| Phone Number:
Address: |
Reference Name |
Phone Number |
Relationship |
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| Interests:
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| Areas of Interest: __Anthropology
__Botany __Geology __Zoology
__Paleontology __Education __Events
__Exhibits __Office Work
__Visitor Services __Grounds |
| Hours available for volunteering / interning:
____Monday
____Tuesday ____Wednesday ____Thursday
____Friday ____Saturday ____Sunday |
Please indicate the statements that best describe how you feel about your
donated time:
- ____ I would like to volunteer or intern on a regular basis at least 2
- 4 hours a week.
- ____ I would like to volunteer once a month for 2 -6 hours at a time.
- ____ I would like to volunteer for special events or special projects
only.
- ____ I would like to be on the volunteer mailing list and be
made aware of individual opportunities to donate my time.
- ____ None of these remarks describe my situation. Please
explain:
|
| Please give a brief statement regarding your objectives in
seeking a Volunteer or Intern position at the Burpee Museum:
|
Signature
_____________________________________________________________________
Date __________________________
| For Office Use Only |
Interviewed by:
Date: |
| Date to Start:
Department:
Supervisor: |
| Requirements: |
| Follow-up Comments: |
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Museum Volunteer page
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