Fill out the form below, and your application will be submitted.

Volunteer Information

Name (First & Last)
Street Address
City
State
Zip
   
Telephone
Email
   
Place of Birth
Citizenship
Sex

Age
Date of Birth
   
Education
Degree/Major
List schooling, training, or past employment which you consider significant to your participation in our  project.
   
Please explain any experiences or past activities, especially volunteer service, that you consider significant to your participation with out project.

 
   
Please explain any past experience working with children.
   
What are your expectations of what life is like here?
   
What knowledge do you have of Native American history or spirituality?
   
Please explain your past experience with drugs/alcohol?
   
Have you used illegal drugs in the past six months? (If yes, please explain)
   
Do you drink alcohol? yes   no
If yes, how much?
   
Why do you feel that you would be a good role model to the youth of our community?
   
Have you ever been arrested? yes   no
Have you ever been convicted of a crime? yes   no
If yes, please explain.
   
Do you have any illnesses, allergies, or disabilities we need to be aware of? yes   no
If yes, please explain.
   
Do you smoke? yes   no
Are you able to work long hours? yes   no
Are you able to adjust to sudden change? yes   no
Are you able to work independently? yes   no
Are you able to live with others in a communal setting? yes   no
Are you allergic to cats or dogs? yes   no
   
Please explain any past experience living with others in a communal setting.
   
Please explain how you deal with conflict?
   
How do you deal with stress?
   
Have you ever lived in a foreign culture?
   
Would you have problems doing any type of physical work? (Examples: cutting lawn, painting, snow shoveling, janitorial work)
   
 Do you have any special talent or skill? (music, art, carpentry, etc.)
   
Do you have any hobbies or interests?
   
Please describe your strengths.
   
Please describe your weaknesses.
   
Please explain what commitment means to you.
   
Why do you want to volunteer with our project?
   
When are you available to volunteer?
   
How long do you want to volunteer for?

Emergency Notification

Name (First & Last)
Relationship
   
Street Address
City, State
Zip Code
Telephone
Email Address

Health Agreement: 

To my knowledge, I do not have health problems or conditions which would prevent me

from participating in volunteer service for the Cheyenne River Youth Project. I understand that I may be

expected to submit a certificate of good health from a physician if I am accepted to the Project. I understand

that I am responsible for all medical costs incurred during my stay.

I understand

*It is recommended that you have some type of medical insurance before your arrival.

Financial Agreement:  

I understand that I am responsible for transportation to and from South Dakota at an

arrival point specified by the Project and that housing is provided as well as a small living stipend.

I understand

Please list the names and addresses of the three individuals who will be writing letters of recommendation on your behalf. The letters of recommendation should be sent directly to:

Billy Mills Youth Center - The Main

Attention: Julie Garreau, Project Director

P.O. Box 410

Eagle Butte, SD 57625

comments, questions or concerns: