Sand Mountain Youth Center    Peer Helper Application
Name____________________________________________________________Age_______

Address__________________________________________________________Sex________

Phone Number_____________________________________________________
Why I would like to work with other youth:

Area of Most Interest (Chaperone Assistant, M.O.S.H. Peer Tutoring, Program Planning) :

List any Civic, Church, or Community Organizations you are a part of
 References:  (Teachers, Supervisors, Church Leaders)
Name____________________________________________________________Phone________
Address__________________________________________________________City___________
Relationship_____________________________________________________________________

Name____________________________________________________________Phone_________
Address_____________________________________________ _____________City__________
Relationship_____________________________________________________________________

Youth Reference:
Name____________________________________________________________Phone_________
Address__________________________________________________________City____________
Relationship______________________________________________________________________
Most convenient time to volunteer: (please list days and times)

Monday-Fridays afternoons or nights?
Weekly_____________Monthly_____________Other_______________

Signed_____________________________________________________
Return to : Sand Mountain Youth Center POBox 2497 Rainsville, AL 35986          
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