Today's date (mm/dd/yy)

First name   Last name

Email   Re-type email 

Street address

City   State Zip

Phone - inc. area code   Best time to call

What is your date of birth? (MM/YY)

Are you a member of our community forum?  Yes No

What is your screen name on our community forum?

Have you ever received financial aid from IMOM? Yes  No

If you have received financial aid from IMOM, what was the date? 
(Month and year)   Name of your PIN

Scheduling

While in training you will be required to read and reply to email from IMOM at least once a day, Monday through Friday.  Are you able to make that commitment?  Yes No

Once training is complete IMOM will need to determine the committee you will be assigned to.  Please tell us which days you are available. Check all days that apply:

Mon.  Tues.  Wed.  Thurs.  Fri.  Sat.  Sun.

Hours available per day:

Example: 8AM - 9PM

Employment & Other Volunteer Work

Are you employed?  Yes   No

What is your occupation?

If you are employed, do you have access to your personal email during working hours?  Yes  No

Are you presently involved in any volunteer work? Yes  No

If yes, for whom do you volunteer?

How long have you volunteered for the above?

What are your volunteer duties?

Do you use an email client for all of your email?  An email client is a program such as Microsoft Outlook.  Yes No

On average, how many emails do you currently receive in one day? 

Are you familiar with the use of email lists/groups?  Yes No

What is the age of the computer you use?

Do you have Microsoft Word or other compatible software? Yes No

Do you have speakers hooked up for your computer? Yes No

Do you have a printer? Yes No

Do you have a fax machine? Yes No

Who is your ISP (Internet Service Provider)

Do you have a telephone calling plan that allows you to make long distance phone calls with no additional charges to your phone bill?  Yes No

Do you have Adobe Reader on your computer so you can open and read PDF documents?  Yes No

Can you open and read Excel spreadsheets? Yes No

How many pets do you have?

Do any of your pets have special needs? Yes No

Tell us about your pet/s with special needs:

What is your opinion on spay and neuter?

What is your opinion on commercial breeding of companion animals?

If you wanted to bring a new pet into your family, how would you go about getting that pet?

Give a brief description of what you would consider to be a reputable rescue organization:

Tell us why you would like to be a volunteer for IMOM:

Additional comments: