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Center Application
Date
Center Name
Address
Mailing Address (if different)
Telephone
Fax
Contact Person(s)
E-mail Address
Are you
4C
Public School
Nonprofit
Other
Are you DCF
Licensed
Yes
No
N/
A
Are you on a public
bus route
Yes
No
If yes, what is the distance to the nearest bus stop?
Do you require
Background
checks?
Yes
No
Are you able to cover the cost of Background
checks?
Is any special
training required to
work at your
Center?
Yes
No
If yes, what and will you provide this?
Number of Volunteers Requested
Please list dates and times Volunteers are
requested
Volunteers for Community Impact
3545 Lake Breeze Drive Orlando, FL 32808
407-298-4180 407-298-2725 (Fax)
www.VolunteersforCommunityImpact.org
Completed by (Please enter your Name)
Date
Please complete the portion below documenting the needs of the clients that you serve, the activities you
would like the volunteer to perform, the desired results of those activities and the impact you hope they will
have.
What needs does your Center have that could be improved by our volunteers?
What types of activities do you anticipate the volunteer will be doing?
Please identify any skills or abilities the volunteer needs to perform activities listed above
Anticipated accomplishments as a result of the activities listed above
Anticipated impact of accomplishments
For Child Care Agencies Only
What are the ages of children served by your Center?
Identify the needs of the children