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Volunteer Profile

Fields below marked with an asterisk (*) are REQUIRED.

User Name*

* Please choose a user name that is a minimum of 4 alphanumeric characters.
Letters and numbers only with no embeded spaces. Example: johnsmith123

Password*

* Please choose a password that is a minimum of 4 alphanumeric characters with no embeded spaces.
Letters and numbers only with no embeded spaces. Example: johnsmith123

Confirm
Password*

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Name*

First:

Last:

Email*

Providing an email address is essential if you want to receive sign up confirmations and schedule notifications. If you do not have email, please check "none".

None
It is critical that we have your email address in case you forget your User Name or Password.

Groups/Teams*:

If you are volunteering as part of a Group or Team, please check all that apply here. This is how the scheduling system knows which works days to display for you. If you are not associated with any Groups or Teams listed here, please check "NONE".

AIG Insurance	Medtronic
American Eagle FCU	Morgan HS Interact Club
Ascend Bank	New Haven Academy
Branford High School Interact Club	North Madison Congregational Church
Christian Public Service	Notre Dame- West Haven
Connex Credit Union	Principle Wealth
CT Bar Association Young Lawyers Section	Quantum-Si
Daniel Hand HS Habitat Club	Quinnipiac Habitat Campus Chapter
Defibtech	Quinnipiac University Physician Assistant Students
Delta Sigma Theta	Raise the Roof
Essex Bank	Rotary Club of Madison
Essex Industries	SALTY
Exchange Club	Shoreline Circle
First Congregational Church of Cheshire	Shoreline Community Church
First Congregational Church, Guilford	Shoreline Pediatrics
First Congregational Church, Madison	Sleeping Giant Build
Guilford High School Interact Club	Spring Glen Church (SGB)
Guilford Newcomers and Neighbors	St. Andrew's, Madison
Guilford Newcomers and Neighbors	St. George Catholic Church
Guilford Surgery	St. Margaret's
Haddam-Killingworth HS Habitat Club	St. Paul VI Parish (SGB)
Hearts and Hammers	Stop and Shop
Hoffmann Architects	Temple Beth Tikvah
Hole in the Wall	The Academy
Hopkins	Turner Construction
INTERSCAPE Commercial Environments	Vox Church
Intrepids Hiking Group	William Pitt Sotheby
JanneyNEWIN	Yale Procurement Community Connections
Knights of Columbus	Yale School of Medicine
Liberty Bank	YNHH- Business Development & Strategic Partnership
Logicbroker	YNHH- Corporate Supply Chain
M & T Bank	YNHH- Office of Strategy Management
Madison Chamber of Commerce	NONE

Gender

Birth Date*
(mm/dd/yyyy)

Address*



City* :	State: Zip:

Phone

Work :
Home*:
Cell :		Carrier:
Fax :

Emergency Contact

Name*:
Phone*:
Relationship*:

Are you 16 or older?*:

Court-ordered community service? How many hours?*:

Are you a military veteran?*:

Interests and Skills

Select all that apply:

Construction

Interested	Some Ability	Professional	None
				Carpentry skills

ReStore

Interested	Some Ability	Professional	None
				Customer Service/Sales
				Heavy Lifting

Office

Interested	Some Ability	Professional	None
				Computer skills (MS Word, Excel, etc.)

Additional Opportunities

List any other skills or physical limitations you may have:

+Required fields