First Name*

Last Name*

E-mail address*

Primary phone number*

Type of phone:
Home
Cell
Business

Best times to call, pls check all that apply:
Morning
Afternoon
Evening
Night

Second phone number (optional)

Type of phone:
Home
Cell
Business

Best times to call, check all that apply:
Morning
Afternoon
Evening
Night

Permanent Address* (Pls include apartment or room # if applicable):

Nation*
Please select...United StatesCanadaAbkhaziaAfghanistanAkrotiri and DhekeliaÅlandAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueBurma MyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern CyprusNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTransnistriaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUnited States Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabwe

If you are under 18 years old, please add your age: 

WORK GROUP CHOICES (can be changed later). Please put a percent in the box(es) for how much of your time you’d like to spend and learn about that activity. (Please choose no more than 5 boxes and leave the rest of the boxes empty. The total should be 100%.) If you’re interested in a very wide range of activities, you can also include “General”. Use the box to the right of your activity choice:

1. END POVERTY CAMPAIGN (EPC) can include many of the activities listed on page 2, but indicate if particularly interested in this global poverty campaign  %

2. EPC Walkathon, other “thons” or fundraising events  %

3. Art, education and activism programs:
Youth for Change  %
Seniors for Change  %

4. GENERAL - our full range of activities  %

5. TRANSLATION into other languages  %

6. MARKETING & COMMUNICATIONS:
Journalism  %
Editing  %
Public Relations  %
Fund Raising  %
Marketing & Publishing  %
Marketing Research  %
Ad Sales  %
Advertising  %
Event Planning  %
Volunteer Recruitment & Personnel  %

7. MANAGEMENT, FINANCIAL, LAW, OFFICE:
Accounting/Bookkeeping  %
Law/Regulatory Compliance  %
Office work (may also include Word, Excel, etc.)  %
Carpentry and Interior Design  %

8. COMPUTERS, TECH, WEBSITE:
Computers/Tech Support (not including office work with MS Word, Excel, etc.)  %
Website Programming/Development  %

9. CREATIVE/GRAPHIC DESIGN:
Website Design  %
Graphic Design for Print  %
Arts Management  %
Artist  %
Photographer  %
Copywriting  %
Creative Writing  %
Youth or Seniors for Change Programs (art, education and activism programs to help end extreme global poverty)  %

VOLUNTEERING SCHEDULE
Our regular hours are 11:30 am - 6 pm on Mondays - Thursdays. We’re also open 10 am - 8 pm on Wednesdays. We close on most major holidays. Schedule subject to change. Please Note: We may open additional evenings and on weekends. Pls. specify all days of the weekend times that you’re interested in, even if we’re not regularly open then:

When would you like to start here*  monthJanFebMarAprMayJunJulAugSepOctNovDec day01020304050607080910111213141516171819202122232425262728293031 year20092010 
This is definite an estimate

If you’re not volunteering with us now, when might we talk again:
monthJanFebMarAprMayJunJulAugSepOctNovDec day01020304050607080910111213141516171819202122232425262728293031 year20092010

INFO SESSION
I would like to attend an info session at 6:30 pm New York City time on a Wednesday.
Click here to pick an info session date:

I can't make that time. Contact me to schedule a different time for my info session.

I can't come in to your office. Please send me info how I can join a conference call for my info session.

SPREAD THE WORD
I would like to help distribute (check all that apply):
Handouts
Posters
E-mails about us to your friends

Others who might be interested in volunteering or interning here? (People can volunteer with us from anywhere in the world.) Pls include their names and phone numbers, if it’s already OK for us to contact them:

 

IN CASE OF EMERGENCY, CONTACT
Required for all. If you are under 18, this must be your parent or legal guardian:

First Name*

Last Name*

Relationship* 

Address (If it's the same as yours, just write “Same” in this box and you can leave the next four boxes empty.)

Nation
Please select...United StatesCanadaAbkhaziaAfghanistanAkrotiri and DhekeliaÅlandAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueBurma MyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern CyprusNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTransnistriaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUnited States Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabwe

Primary phone number*

Type of phone:
Home
Cell
Business

Best times to call, check all that apply:
Morning
Afternoon
Evening
Night

Second phone number (optional)

Type of phone:
Home
Cell
Business

Best times to call, check all that apply:
Morning
Afternoon
Evening
Night

ADDITIONAL INFO AND COMMENTS
I would like more information on (please check all that apply):
End Poverty Walkathon and other events
How my donation can help millions of people
How I can help end global hunger and poverty
Other interesting, valuable volunteer experiences with Hearts & Minds

Comments, special needs, health concerns or other requests (200 characters maximum):

 

 
Check the following box if it is NOT OK to include me on your e-mail list.
(E-mail is used only for contact from Hearts & Minds, usually no more than once a month. We do not sell, rent or lend our list. It is always easy to be removed.):

Check the following box if it is NOT OK to give my phone number and e-mail to a limited number of other Hearts & Minds volunteers who may actively work with me on a specific projects. (Your home address is not included without additional, specific permission from you.):

If you like, you can also send your resume or samples of your work to the mailing address or e-mail address below.

*  Please enter the two words you see below. If you cannot read the characters as they appear, you can either click the reload button (topmost to the right of the yellow rectangle below) to get a new set or click the audio (middle) button to have them read to you.