An Affiliate of  Student Affairs
Cesar E. Chavez Community Action Center
Cesar Chavez Community Action Center :: Week of Service
 
 
 
 
 
 
 
  Volunteer Image  
             
  Volunteer Now * Required fields  
             
  Personal Information   Contact Information  
 
First Name *  
Middle Initial  
Last Name *  
Student ID*  
Class Standing *  
Major*  
 
E-mail Address *  
Phone  
Mailing address  
City  
State  
Zip  
 
           
  Volunteer Information  
 
Have you volunteered with CCCAC before?*   Yes No
       
I am participating in with CCCAC to fulfill a course requirement.*   Yes No
     
If yes, course dept. & no.        Instructor's Name
       
I am performing community service following judge's orders as an alternative to a fine, jail or other sentence.*   Yes No
       
I have been convicted of a felony.*   Yes No
       
I have transportation.   Yes No
       
Bus        Car        Bike              Other(please specify)  
 
I am available during the following days and times. Please select all that apply.
       
  Morning Afternoon Evening
       
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
     
How many hours a week are you available to volunteer? *   hours/week
Which CCCAC signature program are you interedted in? *  
Which volunteer theme are you most interested in? *  
 
   
  Agreement  
  I understand and agree that any misrepresentation by me on this application will be sufficient cause for cancellation of this application and/or separation from service to the Associated Students and the Cesar E. Chavez Community Action Center . I give the Associated Students and CCCAC the right to investigate all references and to secure additional information as necessary about my suitability for volunteer service. I understand that this may include a criminal background check and that all reports, whether oral or written, will be kept strictly confidential and only shared with those persons required by law or whose duty requires them to participate in the decision making process related to my placement as a volunteer.

I, the undersigned, wish to be informed about volunteer service projects taking place near SJSU's campus through the Cesar E. Chavez Community Action Center. I, intending to be legally bound, for myself, my executors, administrators and assignees, so hereby waive and release San Jose State University and the Associated Students, SJSU for damages arising from my participation and travel to and from all volunteer service projects in which I take part. I also certify that I am physically fit to participate in these volunteer service projects.  If I have any needs or require accommodations related to a physical or mental disability, I will inform the CCCAC of my specific needs.

Agree     Disagree

 
             
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