Fields highlighted in red are required*

First Name*: Last Name*:
Date of Birth*: Gender:
Address*: City*: Zip*:
Day Phone*: Evening Phone: Email:
Parent/Guardian Name*: Parent Phone*:

Name of school you are currently attending:
Name of school you will be attending this fall:
Expected Graduation Date:

If you want to volunteer with friends, enter their name(s) here, and be sure they send in an application as well:

1.) 2.) 3.)

VolunTEENS Job Choices
Choose three agencies in case your first or second choices are full:

First Choice Job Title*:
at Agency*: Minimum Age:

Second Choice Job Title:
at Agency: Minimum Age:

Third Choice Job Title:
at Agency: Minimum Age:

Please list skills, talents, hobbies or interests you have below.

How did you or your parent/guardian hear about VolunTEENS? Check all that apply

Friend
School Presentation
School Advisor
VolunTEENS Catalog
Volunteer Center Website
MySpace
Other 

Michigan Student Service Award
The Michigan Student Service Award (MSSA) is a premiere statewide program which recognizes high school students and graduates who volunteer a significant number of hours of service during the course of their high school career. Students who complete 400 hours of service and meet the program requirements receive a MSSA Medallion of Distinction, a Certificate of Distinction for commitment to service from the Volunteer Center of Greater Kalamazoo and Volunteer Centers of Michigan that is signed by the Governor, and inclusion in community-wide recognition efforts in the media and on the Volunteer Center's web site.
If you are interested in receiving further information or applying for this award, please check here:

Please take a moment to double-check the information you provided above and be sure that you have parental/guardian permission to participate. You will receive a confirmation email, if you provided a valid email address, to confirm receipt
of this application. If you have any questions, feel free to email us at VolunTEENS@volunteerkalamazoo.org or call us at
382-8350.