* Name:
* Address:
* City/State/Zip:
* Phone (Daytime):
(Evening):
* Email:
Fax:

Education: (please complete all that apply)
* High School:		* Diploma:	Yes No
College/University:		Years completed:
Major:		Degree:	Yes No
Master's Degree Program:		Years completed:
Major:		Degree:	Yes No
Doctoral Degree Program:		Years completed:
Major:		Degree:	Yes No

Experience
* Current/most recent employer:
* Your title/position:		* Years of service
Previous employer:
Your title/position:		Years of service
Current/most recent volunteer position (name of organization)
Your duties:		Years of service
Current/most recent volunteer position (name of organization)
Your duties:		Years of service

Skills and interests (please check all that apply):

Public speaking    Customer service    Other

Foreign languages spoken Fluency: Basic   Conversational   Fluent

Please list your hobbies and personal interests:

Koshland Science Museum Volunteer Program:
* Why would you like to be a volunteer for the Koshland Science Museum?

* Please describe in detail your professional experience and/or personal interest in science and how that would enhance your volunteer experience with the Koshland Science Museum:

* Please indicate your volunteer shift preference:

References (not related to you):
Mr./Mrs.
Title and/or Organization
Address
City / State / Zip
Daytime phone
Email
Mr./Mrs.
Title and/or Organization
Address
City / State / Zip
Daytime phone
Email