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(if preferred) |
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(if applicable) |
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If no, please fill the below address information.
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Please note that our practice is to reassign Panel Members to their previous panel. Should you wish to be reassigned, please state your prefernces in the Comments box at the bottom of this form.
If you are registering as a new CI Panel Volunteer, how did you learn of this opportunity?
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(wheelchair, etc.) |
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Please provide the following demographic data for use in creating balanced panel representation:
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Potential Conflicts of Interest
List any potential conflicts of interests including any local health and human service organizations with which you or a member of your immediate family currently and/or within the past 5 years serves (or served) as a volunteer, board member or staff member; any member agencies that you were employed by in the past and the dates you were employed by them; any member agencies that you or your employer interact with professionally (i.e. perform annual audit for an agency, collaborate to provide service, compete for funding from the same sources, etc.)
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By clicking the check box below indicates agreement with the following statements:
- I wish to participate as a Community Investments Volunteer. I understand that as a Community Investments Volunteer, I will devote time during regular business hours to attend the Panel/Committee Member Orientation Meeting, panel/committee meetings and agency site visits.
- I have obtained permission from my employer for time required away from work for me to participate as a Community Investments Volunteer.
- I have read and accept the Tulsa Area United Way Code of Ethics.
- I have reviewed the list of TAUW member agencies, and I have disclosed all potential conflicts of interest I may have with member agencies.
- I understand that all of the information member agencies submit to Community Investments Volunteers and all of the materials and discussion generated by the Community Investments Volunteers is confidential, and I agree not to share it with others outside of TAUW Community Investments.
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Areas of Interest
For use in making panel assignments, those interested in a Tulsa based panel should check one (1) of the fields of service listed below in which you have special interest. Those interested in Green Country (Bristow, Sapulpa, Broken Arrow/Wagoner & Okmulgee) should check only the specific location in which you wish to volunteer. TAUW staff will make an effort to assign you to a panel in the area of choice.
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Geographical Area(s) of Interest
Willingness to meet in the following areas:
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