Name       Date of Birth (optional) / /

Address (city, state, zip)

Home Phone ( ) -        E-mail

Emergency Contact Name    Phone # ( ) -  

Volunteer work preferred (please check all areas of interest):
Shelving
Adopt-a-Section (shelf-reading)
Data Entry
Seasonal/Special Occasion Displays
Material Processing
Library Historian
AV Material Cleaning & Repair
Cleaning Books/Dusting Shelves
Handyman
General Clerical
Friends of the LaGrange Library
Other

Please list any skills and special knowledge you have which might be beneficial to the library
(e.g. clerical, computer, working with children, etc.):

Availability:
Would you prefer to have a regular work schedule or work on special projects within a more flexible time frame?

How many hours per week/month would you have to give to the library?

Which days/times are you available to volunteer?

References (work, volunteer, personal):
Please give the names of three references who know of your interests and abilities.

By submitting this online form, I authorize LaGrange Library to make inquiry as to my experience and character,
and to certify that all statements made on this application are true.