Community Health Mission  

310 Eisenhower Drive, 5B

Savannah, GA 31406

912-692-1451

912-352-3980 Fax

mrittmeyer@chmsavannah.org

We deeply appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications.
A clear understanding of

 your interests and background will help us provide the most satisfying volunteer opportunities.

Name___________________________________
Spouse’s Name________________________________

Home Mailing Address___________________________________________________________________

City/State/Zip_______________________________________________________________________

Home Phone_____________________________
Work Phone__________________________________

Email___________________________________ Fax_________________________________________

Alternate Contact__________________________ Phone_______________________________________

Are you employed?________ Where?__________________________ Phone_______________________

Other volunteer experience/contacts________________________________________________________

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Schedule restrictions/preferences?__________________________________________________________

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Schedule restrictions_____________________________________________________________________

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Special abilities/interests_________________________________________________________________

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Signature________________________________

Date____________________________________

Notes:_________________________________________________________________

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