Jackson-Union County Habitat for Humanity
Volunteer Interest Survey


(Please Print)

Name ___________________________________ Home Phone ____________________

Address__________________________________ Work Phone ____________________

City, State, Zip ___________________________________________________________

E-Mail Address ___________________________ Fax/Cell Phone __________________

Employer _______________________________ Occupation ______________________

(Please Circle)

Availability:    Mornings    Afternoons    Evenings    Weekdays    Weekends    Summer
Construction Interests:  Supervisor    General Labor    Excavation    Masonry   Rough Carpentry
Finish Carpentry    Plumbing    Heating    Electrical    Roofing    Insulation    Siding    Drywall    Painting
Cabinets    Floor Coverings    Landscaping

Office Interests:     Data Entry    Accounting    Bulk Mailings    Phoning    General Office Duties

Other Interests:     Food Preparation    Special Events    Administration/Management   Fundraising       
Public Relations    Church Relations    Public Speaking    Family Nurture    Grant Writing    Family Selection

Please list any experience you have in the interests you’ve circled:  (Note, no experience is necessary as all volunteers are welcomed and encouraged to participate) _____________________________

____________________________________________________________________________________

Briefly describe how you would most like to benefit our organization:
____________________________________________________________________________________
____________________________________________________________________________________

If you would also like to make a monetary donation, please make your check payable to Jackson-Union County HFH and include it when you return this form.

Please complete and mail to:     Jackson-Union County HFH
                                                Lee E. Brackett, President
                                                300 E. Main Street, Suite #6
                                                Carbondale, IL 62901
Phone: 618.457.8480
E-Mail:  lee@brackettinsurancegroup.com
Website: www.JUCHabitat.org                                     Thank You!