AMERICAN RED CROSS of AUGUSTA- YOUTH VOLUNTEER PROGRAM 1322 Ellis Street Augusta, GA 30901 Ph# (706) 922-8484

FAX # (706) 724-8485

This section must be completed by the YOUTH: Name: Katie Chiou Home Phone: 706-504-4248 Cell Number: 706-941-2545 Address: 3526 Granite Way City: Martinez, GA Zip Code: 30907 Age: 13 Date of Birth: 10/17/1998 School: Lakeside High School Grade: Rising 9th Grader E-mail address: kchiou_5683@aol.com OR kchiou_5683@hotmail.com Have you ever done any volunteer work? yes middle school library shelving books. Please list interests, hobbies and school, church or social activities: For school activities, I'm a part of my school's concert and marching band (Clarinet). I also play violin, piano, and I just began teaching myself to play guitar. During the 2011-2012 school year, I was a part of my school's Yearbook staff which had 6 members who applied by application and were narrowed down. I was a member of the Academic team; and also the Math team, for which I made it individually to the State competition. During the 1st semester of the '11-'12 year, I was a part of the Greater Augusta Youth Orchestra at ASU. In my free time, I usually listen to music, and I also run around my neighborhood a lot to keep active. How would you describe yourself to someone who doesnt know you? To someone who doesn't know me, I'd describe myself as friendly, outgoing, really easy to get along with, and definitely a hard worker. I can never stop doing something until I finish it. Briefly state why you want to be a volunteer: The reason I want to be a volunteer is because I really would like to give back to the community. I want to help people who can't necessarily help themselves. If so, what kind? I often helped out in my

______________________________________________________________________ What qualities or skills do you have which would make you a good volunteer? One good quality I have is that I'm always willing to follow orders. I'm very easy to get along with, friendly, and I always make sure that when I do something, I do it to the best of my ability.
Please select the activities which interest you:

Hospital ________X__ Nursing Home ______

Child Development ________ Tutoring _____X____

Food Bank _X_______ Computers_______ Disaster Relief ____X___

Office Work _______ (receptionist, typing)

How many days per week would you like to volunteer? 1-2 How did you find out about the Red Cross volunteer program? ____School ____Church ___Radio ___Newspaper ___TV ___Parents _X___Friend If a friend, who ? Priya Merai REFERENCE: Please give the name and phone number of one of your school teachers who is familiar with your abilities.

Teacher's Name

Mrs Osment (7th grade homeroom teacher, and director of SIMS Yearbook Staff) School Phone # (706) 447-2106

All applicants must complete a personal interview at the Red Cross office, accompanied by a parent. I understand that I must complete required training and comply with all necessary rules to become a Red Cross volunteer. Signature of Volunteer_________________________________ -----------------------------------------------------------------------------------------------------THIS SECTION TO BE COMPLETED BY PARENT IN CASE OF EMERGENCY: Mother's Name: Huiying Sun Home Phone: 706-504-4248 Name of work place and phone: Savannah River Site 803-952-6774 Fathers Name: JD Chiou Home Phone: 740-835-6707 Name of work place and phone: Savannah River Site 803-952-5661 My son/daughter has my permission to serve as a Red Cross volunteer. I will advise the Red Cross Youth Director of any conditions that might limit my childs ability to serve as a volunteer. I understand that transportation is my responsibility and that I will be notified of any problems involving his/her volunteer service. Signature of

Parent:____________________________________Date__________________