College Students

Is this a...*
- Practicum
- Field Study
- Service Learning
Your Name*
First Last
Birthday*
Month
Day
Year
Email Address*

That is checked regularly.
Phone Number*
Address*
Street Address Address Line 2 City State ZIP Code
Emergency Contact*
Emergency Contact Phone Number*
Name of College or University*
Field of study or class requiring volunteering services*
How many hours do you need to complete your class requirements?*
What is your availability to complete these hours?*
Do you have any special needs you would like us to accommodate? If so, please explain.
How did you hear about us?*
Please tell us why you would be a good candidate for our organization*
Please tell us what you hope to gain by completing your volunteer service with us*
Authorization*
- I authorize
I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for may prohibit me from volunteering with Infant Crisis Services.
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Infant Crisis Services, Inc
Donald W. Reynolds Center
4224 N. Lincoln Blvd
Oklahoma City, OK 73105
405-528-3663

Donor door hours are:
Monday – Friday 8:00 am to 5:00 pm and Saturday 9:00 am to 12:00 pm.
Service hours are:
Monday – Friday 9:00 am to 4:00 pm and Saturday 9:00 am to 12:00 pm.