Volunteer Interest Form

Please fill out the following interest form.

Name(Required)
Address
Email(Required)
Emergency Contact Information
Are there any tasks or work that you would not be able to perform?(Required)
Do you require any special accomodations?(Required)
What are your areas of interest?(Required)
Are you fulfilling community service hours?(Required)
Do you require written documentation of hours?(Required)
Do you have any criminal convictions (other than traffic violations or minor juvenile offenses)?(Required)
Thank you for your interest in volunteering for the Brain Injury Association of Virginia. Someone will contact you shortly.
BIAV is an equal opportunity organization and will not allow discrimination based upon age, ethnicity, ancestry, gender, national origin, disability, race, size, religion, sexual orientation, socioeconomic background, or any other status prohibited by applicable law.