Volunteer for Meals on Wheels Volunteer for Meals on Wheels Are you volunteering as(Required) Individual Corporation or Organization Corporation or Organization Name Are you volunteering for:(Required) Meal Delivery Kitchen Help Both Legal Name(Required) First Last Preferred Name First Last If you have a name you prefer over your legal name, please let us know. You may skip if not applicable.Preferred Pronouns(Required)She/Her/HersHe/Him/HisThey/Them/TheirsOtherPrefer Not to AnswerBirthday(Required) MM slash DD slash YYYY Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Prefrence(Required) Phone Text Message Email Select AllCell Phone Number(Required)Alternate Phone NumberPlease skip if you do not have one. What are your volunteer interest? Meal Delivery Special Events Meals on Wheels Congregate Site Substitute Administrative Work / Clerical Distribution Coordination May we send you(Required) Text Messages Emails Select AllEmployer or Retired From(Required) Email(Required) Emergency Contact(Required) First Last Please provide an emergency contact for yourself.Emergency Contact Phone Number(Required)Emergency Contact Relationship(Required) When are you available to volunteer?(Required)MondayTuesdayWednesdayThursdayFridayPlease check all that apply.How often would you like to volunteer?(Required)As often as needed1 time per week2 times per week3 times per week1 time per monthOtherSubstituteDo you need to fulfill school service hours?(Required) Yes No Are you a Veteran? Yes No If you are a Veteran, which branch? You may skip if you are not a veteran. What is your ethnicity?(Required) Asian Black/African Hispanic Caucasian/White Native American Pacific Islander Prefer Not to Answer Other Select all that apply. Have you been convicted of a crime that would make you ineligible to volunteer? If yes, please explain.How did you hear about us?Would you consider a leadership role to be a mentor for Meals on Wheels Yes No Unsure I give my permission for my photo to be used for promotion of volunteers in the event that it is taken. Yes No Please Ask with Each Use Driver / Delivery Volunteers OnlyPlease answer the following questions if you intend to deliver Meals on Wheels. If you’re applying for kitchen help only, you can skip this section. Lawrence Volunteers: What is your preferred pick-up location? West Lawrence East Lawrence No Prefrence Please skip if you are not located in the Lawrence area.Topeka Volunteers: What is your preferred pick-up location? East Topeka Central Topeka Oakland North Topeka West Topeka Tecumseh – Shawnee Heights UMC No Prefrence Please skip if you are not located in the Topeka area.If you plan to deliver with a partner, please list their name and phone number: Do you have a valid drivers license? Yes No Do you have current vehicle insurance? Yes No Are you available as a substitute driver if needed? Yes No
