CCYT Volunteer Application

At the bottom of this application please use the volunteer documents section to upload a copy of your driver's license and car insurance. You will need to use the drop down box to select the number two in order to upload both documents.

If you have children, please use the CCYT Volunteer Children section to select the number of children in your home.

Main Contact Information First Name* Last Name* Street Address* City* State/Region* AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Zip Code* Home Email* Phone Number* ()-ext Enter Int'l Number Gender* Agender Female Gender Fluid Gender Queer Male Nonbinary Transgender, female Transgender, male Two Spirit Prefer Not to Answer Questioning   Preferred Pronouns* He/Him/His She/Her/Hers They/Them/Theirs Ze/Zir Other He/She   Race & Ethnicity* African American Indian or Alaska Native Asian Black or African American Hispanic or Latinx Multiracial Native Hawaiian or Other Pacific Islander Other White or Caucasian   Birth Date* Are you a licensed foster parent?* YesNo What CPA are you licensed with? Additional Adult Information If there is another adult in your home please fill out this section. Person 2 First Name Person 2 Last Name Additional Full Address Person 2 Email Person 2 Phone Number ()-ext Enter Int'l Number Person 2 Gender Agender Female Gender Fluid Gender Queer Male Nonbinary Transgender, female Transgender, male Two Spirit Prefer Not to Answer Questioning   Person 2 Preferred Pronouns He/Him/His She/Her/Hers They/Them/Theirs Ze/Zir Other He/She   Person 2 Race & Ethnicity African American Indian or Alaska Native Asian Black or African American Hispanic or Latinx Multiracial Native Hawaiian or Other Pacific Islander Other White or Caucasian   Person 2 Birth Date Volunteer Questions How did you hear about Community Connections YouThrive?* Have you or anyone in your household ever been convicted of a felony or crime against a person?* YesNo Please explain any convictions Have you ever been terminated from a paid or volunteer position as the direct result of misconduct with a child or lying about criminal history?* YesNo Please explain any terminations Acknowlegements I affirm that the facts set forth in it are true and complete. I understand that if I/we become a Support Family, any false statement, omissions, or other misrepresentations made by me/us on this application may result in dismissal* I give FosterAdopt Connect permission to share information about me with a potential youth for matching purposes*

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