| NAME: (Last, First, Middle) | |
| ADDRESS: (Street) | |
| ADDRESS: (City, State, Zip) | |
| TELEPHONE: (Home, Work or Cell) | |
| EMAIL ADDRESS: | |
| PREFERRED CONTACT METHOD: | Telephone Email |
Optional Questions (Please check all those that apply): |
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| GENDER: | Female Male Other |
| AGE: | 16-24 25-34 35-49 50-59 60-69 70 and up |
| ETHNICITY: | Gujarati Non-Gujarati |
Please tell us why you are interested in serving as a Community Action Team member and describe the particular qualifications, skills or qualities that you would bring to this role. You may type up your statement and attach it to your application. Limit to 200 words. REFERENCES: Please provide the names and contact information of three community, professional, or volunteer references (please do not include relatives). |
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| Name/Title | Phone/Email | Occupation/Affiliation |
I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT ANY FALSE INFORMATION ON THIS APPLICATION MAY BE GROUNDS FOR NOT HIRING ME. If you have any questions please call 734.615.4116 or 1.888.4SHANTI Thank you for your interest in The Shanti Project and for completing this application |
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