Volunteer Application

If you would like to volunteer for the Give Back Garden use our Give Back Garden volunteer form. If you would like to volunteer for the Medical Reserve Corp complete an application on the Illinois Volunteer Management System website.

Information is valid
You must make a selection

Contact information
Name field is valid
Name field is invalid or blank

Date of birth field is valid
Date of birth is invalid or blank

Address name field is valid
Address name field is invalid or blank

City field is valid
City field is invalid or blank

State name field is valid
State name field cannot be blank

Zip code field is valid
Zip code is blank or invalid.

Email field is valid
Email field is invalid or blank

Business phone number field is valid
Phone number field is invalid or blank

License field is valid
License field is invalid or blank

Skills and experience
Experience field is valid
Please enter some information here.

Field is valid
Please enter some information here.

Availability
hours field is valid
Hours field is invalid or blank

Start time is valid
Start time must be selected
End time field is valid
End time must be selected
Date field is valid
Date field is invalid or blank.
Date field is valid
Date field is invalid or blank.
Comments field is valid
Please enter some information here.

Additional
Field is valid
Please enter some information here.

Please read the following carefully before signing this application

I understand that this is an application for a volunteer opportunity not an employment agreement. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with Champaign-Urbana Public Health District or my termination as a volunteer.