Volunteer Application

Applicant Information

First Name *

Last Name *

Phone Number *

Email Address *

Street Address *

Apartment/Suite/Unit

City

State

Zip Code

Are you over the age of 18? *YesNo

How did you hear about Lighthouse of Pinellas?

Emergency Contact Information

Emergency Contact Full Name *

Emergency Contact Relationship *

Emergency Contact Phone Number *

Volunteer Pathway

Lighthouse of Pinellas offers several ways to get involved. Please select the area(s) that interest you: *Direct Service Volunteer (Requires Level 2 Screening)Indirect/Support VolunteerOngoing Event VolunteerOther

Feel free to share more about how you'd like to get involved.

Availability & Skills

How many hours per month would you like to volunteer? *

Preferred days & times:

Special skills (technology, languages, certifications, etc.)

Medical & Accessibility Information

Optional medical, accessibility, or accommodation information

Background & Screening

Have you ever been convicted of a crime relevant to working with vulnerable populations? *YesNo

Are you currently subject to any legal restrictions (probation/parole)? *YesNo

Are you volunteering to fulfill required service hours (school/court)? *YesNo

If yes, please explain. *

Agreements & Consent

Photo & Media Release *I grant permission for Lighthouse of Pinellas to use photos/video of me for promotional purposes.I do not grant permission.

Volunteer Agreement & Electronic Consent

I certify that the information provided in this application is true and complete to the best of my knowledge. I authorize Lighthouse of Pinellas to conduct any applicable background screening related to volunteer placement. I understand that volunteer placement is contingent upon organizational needs and, when applicable, successful completion of required screening. I understand that Lighthouse of Pinellas is dedicated to empowering individuals who are blind or visually impaired to live independently and achieve their goals. I agree to uphold the dignity, independence, inclusion, and confidentiality of those we serve.

Type Your Full Legal Name *Typing your name here serves as your electronic acknowledgment and consent.

Make a Difference Through Volunteering