Society for the Physically Disabled

1. Salutation Choose Dr Mr Mrs Ms Mdm
2. Name of Volunteers *
3. NRIC / Passport No. *
4. Date of Birth (Day) 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Date of Birth (Month) * Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Date of Birth (Year) * 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930
5. Gender Choose Female Male
6. Email Address *
7. Home Address *
8. Postal code *

1. Contact No (Home) *
2. Contact No (Office)
3. Contact No (Mobile)

1. Nationality
2. Race
3. Marital Status Choose Single Married Separated Divorced Widow Widower
4. Highest Education
5. Preferred Calling Time
6. Do you drive? Choose Yes No
7. Occupation
8. In case of emergency, pls contact
9. Language Spoken Choose English Mandarin Malay Tamil Others
10. Language Written Choose English Mandarin Malay Tamil Others
11. Dialects Spoken Choose Hokkien Teochew Khek (Hakka) Cantonese Hainanese None
12. Computer Literacy Choose Microsoft Word Excel Powerpoint Access Others
13. Frequency of volunteering Choose Daily Twice a week Once a week Once a month One time project Anytime
14. How did you hear about us? Choose Printed advertisement SPD website Referred by friend / volunteer Recruitment Drive Others

Please choose day & time mon-sun, morning, afternoon, evening or whole day

1. Day(s) for a weeks(Days) Choose weeks Whole weeks Once a week Twice a week Three times a week Four time a week Five time a week Six time a week
2. Time Times Choose time Whole day Morning Afternoon Evening
3. Length of Volunteering Commitment
4. Special Skills
5. Past Volunteering Experiences

6. Area(s) of Interest	Programmes	Please Tick The Appropriate Box
   Ad-hoc Basis	One-Time Assignments (Fund-Raising/Administration/Social & Recreational Activities/Others)
   Short-term & On-going Basis	a) Administration
   	b) Befriending
   	c) Care Giving Services
   	d) Fundraising
   	e) Handicraft Making
   	f) Rehabilitation Service Support
   	g) IT Training & Service Support
   	h) Tuition
   	Level mainstream: Subject(s):