OFFICE OF HUMAN RESOURCES ACADEMIC SERVICES #241 | 400 EAST MAIN STREET FRANKFORT, KY 40601 | (502) 597-6667 KYSU.EDU
VOLUNTEER APPLICATION
First Name
Middle Name
(Last Name)
First Name) Middle Name (Last Name) (Required; Enter N/A if None)
Address 1: ___ Address 2: ___
Address 1
Address 2
City: ___ State: ___ ZIP: ___
City
State
ZIP
Phone Number: ___ Email Address: ___
Phone Number
Email Address
Gender: ☐ Male ☐ Female ☐ Do not Wish to Self-Identify Date of Birth: ___
Date of Birth
Gender
Gender
Gender
Are you legally authorized to work in the United States? ☐ Yes ☐ No
Are you legally authorized to work in the United States
Are you legally authorized to work in the United States
Emergency Contact
Name: ___ Relationship: ___
Name
Relationship
Phone Number: ___ Email Address: ___
Phone Number
Email Address
Volunteer Information
Area of Interest / Department: _____ Supervisor / Mentor _____
Area of Interest / Department
Supervisor / Mentor
Supervisor / Mentor Signature: ___ Date: ___
Supervisor / Mentor Signature
Date
Do you have any physical limitations or health concerns we should be aware of? ☐ Yes ☐ No
Do you have any physical limitations or health concerns we should be aware of
Do you have any physical limitations or health concerns we should be aware of
If yes, please explain:
___
If yes, please explain [1]
If yes, please explain [2]
If yes, please explain [3]
Do you have prior volunteer experience? ☐ Yes ☐ No
Do you have prior volunteer experience
Do you have prior volunteer experience
If yes, please list organization(s) and dates:
If yes, please list organization(s) and dates [1]
If yes, please list organization(s) and dates [2]
If yes, please list organization(s) and dates [3]
Revised: September 2025