First Name

Last Name

Are You an Individual or with a Group Are You an Individual or with a Group Individual Group

Are you fluent in ASL? Are you fluent in ASL? Yes No

Name Of Group

Number of Volunteers

Company/Organization Name

Street Address

Apt/Unit/Suite

City, State, Zip

Phone Number

Email Address

Have you volunteered with Chicago Hearing Society before? Have you volunteered with Chicago Hearing Society before? Yes No

Have you ever been employed by Chicago Hearing Society? Have you ever been employed by Chicago Hearing Society? Yes No

Do you have any experience working with people who are Deaf, DeafBlind or Hard of Hearing? Do you have any experience working with people who are Deaf, DeafBlind or Hard of Hearing? Yes No

If yes, please describe. If no, please tell us what made you consider this program? Why are you excited to volunteer for CHS (ex: is this required for your school)?

When would you like to volunteer? Please note that our office is open weekdays from 8:30 am - 4:30 pm with some programming in the evenings and weekends.

What volunteer service would you like to provide? What volunteer service would you like to provide? Tutor Help with special events Offer presentation as a Deaf adult Provice Office Support Read stories in ASL Service as direct support to people