Contact Information

Availability
During which hours are you available for volunteer assignments? Days of the week available?
Select all that apply.

Interests
Tell us in which areas you are interested in volunteering
Select all that apply
(Note: Fields marked with “*” indicate the need for local residents – Dayton, Ohio)

Person to Notify in Case of Emergency

Agreement
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Our Policy
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

All personal information is treated as confidential. VIASAR adheres to the Privacy Act of 1974
5 U.S.C. § 552a (As Amended).

Thank you for completing this application form and for your interest in volunteering with us.

Please direct all questions and comments to:

Christopher J. Rowley
President and CEO, VIASAR
Director of Operations
334 Park Drive
Dayton, OH 45410
(937) 401-4142
crowley@viasar.org

Kevin R. Culli
Vice President, VIASAR
Director of Standards and Certification
2341 Spyglass Ct.
Fairborn, OH 45234
kculli@viasar.org