VOLUNTEER APPLICATION

Connecticut Radio Information System Phone: 860-527-8000

184 Windsor Avenue, Suite C Fax: 860-727-9581

Windsor, CT 06095-4536 E-mail: crisradio@snet.net

Mr. Mrs. Ms. Last Name: ___________________ First Name: _  _____   _____

Address:

Town: ________ State: ______Zip Code: ____

Home Phone: _________Work Phone: ____________ Cell Phone:

Home E-mail: Work E-mail:

VOLUNTEER PREFERENCES

Please check your preference(s)

Reader-Live Reader-recorded Board Operator, audio editing

PR assistant Speaker’s Bureau Clerical/Office

Mailing Projects Telephone Board of Directors

Indicate studio preference: Windsor Danbury Norwich Trumbull West Haven

If you are available for the Speaker’s Bureau, list towns or areas where you are willing to travel:

_____________________________________________________________________________

How did you learn about CRIS? ____________________________________________________

Current employer (school if student): _______________________________________________

Retired from: _______________________________________________________________

Volunteer experience: ___________________________________________________________

____________________________________________________________________________

IN CASE OF EMERGENCY

Person to notify ______________________Relationship ______________ Home Phone: _________Work Phone: ______________ Cell: ___________

application continues on other side

VOLUNTEER AVAILABILITY

My schedule is flexible

I am available as follows:

Day(s) of Week _____________Hours: ___________________ am pm

Some grant funding sources require CRIS to report information about volunteer age, race and disability status. This information is not used for any other purposes. Your cooperation is requested, but not required for volunteer service.

Ethnicity: Caucasian African-American Native American Hispanic Asian

Do you have disability? No Yes Please define ______________________

Date of Birth_____-_____-_____

TALENT RELEASE

I grant authority to Connecticut Radio Information System, Inc., and those acting within its authority, to distribute via radio, television, telephone, and the internet my name and all live or recorded readings and/or performances submitted by me. Authority is also granted to record and copy my submitted readings and/or performances to audiotape, cd, or any other medium, for distribution to individuals or groups as Connecticut Radio Information System, and those acting within its authority, deem appropriate.

Signature of Volunteer Date

Signature of Parent or Guardian [if volunteer is under 18] Date

STATEMENT OF CONFIDENTIALITY

I promise to respect the privacy and confidentiality of all listeners of CRIS.

Signature of Volunteer Date

Return Application to: Connecticut Radio Information System, 184 Windsor Ave., Suite C, Windsor, CT 06095.

For CRIS Office

Interviewer Comments:

Interview Date: Assignment:

Interviewer’s Signature: Date:

CRIS Rev. 9/07