Name
Sex	MaleFemale
Birthdate
Address
City	Zip
Home Phone		Work phone
May we contact you here:	Yes No		Yes No
Email
Education	Please Select highest grade completed: Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 College 1 College 2 College 3 College 4
Degree
Skills (typing, etc)
Hobbies/Interests
Have you ever done volunteer work before? YesNo
If yes, when and where?
What duties did you have?
How did you hear about us?
Please mark all areas that interest you:	Hospital or home visits HIV/AIDS Education Food Pantry Fundraising Office Work Phones Prevention Packets Street Outreach

Privacy: I understand that I am not to reveal the HIV status of any individual made known to me through association with The Philadelphia Center. I will sign a statement of confidentiality before beginning any volunteer work.

By submitting this application, you agree to the above and will sign a statement of confidentiality before beginning any volunteer work.