| Please complete this survey to assist in determining your gifts and interests. Please print this page and complete the survey in print. |
| Name: _______________________________________________ |
| Address: _____________________________________________ |
| City: ___________________________ |
St.: _____ |
Zip: ______ |
| Phone: |
Daytime: ___________ |
Evening: ____________ |
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Cell:_______ |
Fax: ______________ |
| E-mail address: ____________________________________________ |
| Age (please check one) |
| Under 18 ___ |
18-25 _____ |
25-45 _____ |
45-60 ______ |
60 and older ___ |
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| Local Church Membership: ____________________________________ |
| District: __________________________________________________ |
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| Below are examples of skills. Please check next to skills you have (if you are a professional or licensed in a particular skill, plese indicate with a P or L in the box. |
| Construction |
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Teaching |
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| Architect |
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Teaching Youth |
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| Building Contractor |
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Teaching Children |
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| Surveyor |
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Tutoring |
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| Building Consultant |
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Preschool |
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| Security Consultant |
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Day Care |
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| Carpentry |
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Music |
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| Electrician |
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Bible School |
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| Heating/Cooling |
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Puppets/Clowing |
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| Plumbing |
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Crafts |
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| Roof/Spouting |
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Canning/Food Prep. |
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| Landscaping |
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Sewing/Tailoring |
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| Brick/Block Laying |
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Gardening/Agriculture |
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| Concrete Work |
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Nutritional Planning |
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| Paving |
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Household Budgeting |
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| Heavy Equip. Op. |
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Weaving |
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| Dry Wall Hanging |
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| Dry Wall Finishing |
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Medical |
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| Plastering |
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Physician |
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| Painting |
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Nurse Practitioner |
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| Draperies |
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Nurse |
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| Flooring |
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Dentist |
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| Insulation |
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Optometrist |
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| Glass/Glazing |
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Pharmacist |
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| Construction Helper |
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Dental Hygienist |
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| Business |
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Therapy |
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| Administrative |
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Signing for Deaf |
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| Accounting |
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Braille/Speech |
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| Bookkeeping |
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Hearing Therapy |
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| Business Mgmt. |
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| Computer Repair |
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Other Skills |
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| Computer Operator |
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Stain Glass Repair |
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| Computer Programmer |
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Organ Repair |
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| Computer Consultant |
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Furniture Repair |
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| Lawyer |
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Door/Hardware Repair |
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| Secretary |
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Electronics Repair |
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| Videographer BVD |
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Welding |
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Metal Work |
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| Automotive |
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Steeple Jack |
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| Auto Repair |
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Cook/Meal Prep. |
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| Semi-truck driver |
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HAMM Radio Operator |
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| Other, please describe: |
| Other construction: |
| Other automotive: |
| Other Medical: |
| Other Business: |
| Other Teaching: |
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| Please select the most desirable months of the year to serve as a volunteer: |
| JAN. |
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FEB. |
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MAR. |
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APR |
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MAY |
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JUNE |
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| JULY |
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AUG |
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SEPT |
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OCT |
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NOV |
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DEC |
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| Please select the most convenient days of the week for you to serve as a volunteer: |
| MON |
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TUES |
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WED |
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| THURS |
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FRI |
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SAT |
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| SUN |
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| Would you prefer to serve (check all that apply): |
| Local Volunteers In Mission |
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Domestic (National) Volunteers In Mission |
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| International Volunteers In Mission |
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International Disaster Response |
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| Local Disaster Response |
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National Disaster Response |
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| Please list any foreign languages in which you are fluent: |
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| Do you have any physical limitations? If so, what are they? |
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| Would you like to be informed of future trainings for: |
| Volunteers In Mission |
____ |
|
Disaster Response |
____ |
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| Please mail completed form to: |
| Kansas East Conference UMC |
| Volunteers In Mission |
| PO Box 518 |
| Elwood KS 66024 |
