Application Form

Please complete this form and Sam Burke, Family Services Coordinator, will respond shortly. Thanks!

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Ronald McDonald House Charities of Eastern Iowa • 730 Hawkins Dr. • Iowa City, IA 52246-2509 • Phone: 319-356-3939 • iowacityrmh@gmail.com

* Date
* Name
* Email
* Birthdate
Street Address
City
State
Zip Code
* Home or Work Phone
* How did you hear about the Ronald McDonald House?
* Why would you like to volunteer at the Ronald McDonald House?
* Have you read the job description?	Yes No
* Have you ever been convicted of a crime? If so, please explain
* Are you able to make a six month committment to the house?	Yes No
* Which days of the week work best for you?	Monday (9:00 - noon) Monday (noon - 3:00) Monday (3:00 - 6:00) Monday (6:00 - 9:00) Tuesday (9:00 - noon) Tuesday (noon - 3:00) Tuesday (3:00 - 6:00) Tuesday (6:00 - 9:00) Wednesday (9:00 - noon) Wednesday (noon - 3:00) Wednesday (3:00 - 6:00) Wednesday (6:00 - 9:00) Thursday (9:00 - noon) Thursday (noon - 3:00) Thursday (3:00 - 6:00) Thursday (6:00 - 9:00) Friday (9:00 - noon) Friday (noon - 3:00) Friday (3:00 - 6:00) Friday (6:00 - 9:00) Saturday (9:00 - noon) Saturday (noon - 3:00) Saturday (3:00 - 6:00) Saturday (6:00 - 9:00) Sunday (9:00 - noon) Sunday (noon - 3:00) Sunday (3:00 - 6:00) Sunday (6:00 - 9:00)
Anything else we need to know about your schedule? Would a different 3-hour time slot work better for you?
* Is your volunteer work to complete community service hours or a requirement for school?	Yes No
Do you have any talents or interests (besides volunteering) that you think could benefit the House?
Thank You!