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Northern Kentucky Independent District Health Department Volunteer Application

If you are interested in volunteering in any capacity for the Northern Kentucky Health Department, please complete the following form. If you are a student seeking to obtain credit for educational purposes, please fill out our internship interest form.

Contact Information:

  State:   Zip Code:

I. Skills and Interests

Is there a particular type of volunteer work you are interested in?







Other:

Is there a person or group you are particularly interested in working with?




Other:

Are there any groups you are NOT interested in working with?




Other:

Why are you interested in volunteering with our organization?

II. Availability

How often would you be interested in volunteering?

Are you interested in volunteering for a specific time period?

If yes, please specify:

When are you available to volunteer?



Do you have a preference as to where you do volunteer work?

If yes, please select a location:






Do you have access to a vehicle you can use for volunteer work?

III. References



Other:

List name and phone number of two personal references:

Name:   Phone:
Name:   Phone:

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