Date:
Name of Organization:
Street Address:
City:
State:
Zip:
County:
Daytime Phone:
Fax:
Email: *Required	(Ex: email@yoursite.com)
Home Address:
Home City:
Home State:
Home Zip:
Professional Status:
CPA CMA Bookkeeper Accountant Consultant Faculty Other:
Do you speak any foreign languages? If so, which?:
Areas in which you could provide assistance to clients:
Nonprofit Bookkeeping Nonprofit Reporting Requirements Nonprofit Accounting 501(c)(3) application Payroll Understanding Financial Statements Budgeting
Computer software you are comfortable training a client on:
Quickbooks Excel Peachtree Other:
Limitations on Volunteer Assignment:
Geographic:
Time:
If interested, what type of organization would you like to serve on Community Accountants on Boards and Committees? What type of organization would you like to volunteer for Direct Service?
Community Development Corps Health Care/Mental Health Cultural/Arts Organization Religious/Ethnic Institutions Educational Institutions Senior Citizen/Aging Services Youth Counseling/Services Other:
List Two References: Name and Address with Phone/ E-mail:
Please Attach a Current Resume: