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First name:
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Middle name
Last Name
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Address
Address 2nd Line
Address 3rd Line
City
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Province
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Postal Code
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Email
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Phone Number 1
Phone Number 2
Fax
Volunteer Interests
Office Volunteer
Employment Mentor
Translation
Web Design
Graphic Design
Fundraising
Special Event Volunteer (i.e. Black History Month, Ottawa Kwanzaa celebration)
Office and Administration Support
JK Black Star Tutoring Program
Public Outreach Volunteer
Please list any special skills (language, fundraising, communication, etc.) that you have acquired through work, school, or by any other means that you might consider using to support our volunteering efforts:
Are you currently professionally employed?
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If yes, what is your professional or business affiliation?
Are you retired?
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If yes, what was your former occupation?
Are you a student?
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If yes, please list your grade, school, and/or major:
Are there any additional interests/skills relevant to volunteering that you would like to share?
Additional Information (Optional)
Please list any health related or other limitations/concerns that we should be aware of:
How did you hear about Jaku Konbit?
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