Homeowner and Renter Assistance - Volunteer Application

Homeowner and Renter Assistance - Volunteer Information

NOTE: * Indicates required field

First name*		Site number
Initial		District*
Last name*
Mailing address*		Area code and Daytime phone number*
Apt. #, space, etc.		Email address*
City*
State	CA
Zip Code*	-

1. Is this your first year as a HRA volunteer?	If you answered yes, go to question 3.
2. If no, how many years have you been a HRA volunteer including this year?
3. Are you also a VITA or TCE volunteer?
4. Are you currently employed?	If you answered no, go to question 7.
5. Will you assist claimants during work hours as part of your paid job?
6. Will you assist claimants after work hours at your job site?
7. Are you available to assist a shut-in?
8. If you offer volunteer assistance in any language other than English, please list language(s):