Form 1 Conference Registration Form

NCVS Registration Form

Other Organization Rep. Category (Choose One):  

• PeaceCorps

• Business

• Foundation

• Government

• International

• Nonprofit

• K-12 Admin/Teachers

• University/Colleges

• Student rate (copy of valid student ID required)

If other, please specify:

What is your Gender?

• Male

• Female

• Other

Ethnicity: Are you of Latino or Hispanic origin or descent, such as Mexican, Puerto Rican, Cuban, or some other Latin American background? (SELECT ONE)

• Yes – Hispanic or Latino

• No – not Hispanic or Latino

•  

• Race: What is your race? Are you white, black or African American, Asian, American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander? You may select more than one race. (SELECT ALL THAT APPLY.)

  
  

  • White

  • Black/African American

  • Asian

  • American Indian or Alaska Native

  • Native Hawaiian or other Pacific Islander

  
  

What is your age?

• Under 18

• 18 to 24

• 25 to 34

• 35 to 44

• 45 to 54

• 55 to 64

• 65 and over

Please indicate what type of organization or entity you represent (Choose one):  

• Business/Corporate Service Council

• Faith Based

• Government

• Nonprofit

• University/College

• K-12 Administrators/Teachers

• Foundation

• Other (please specify below)

Organization or entity other:

Please indicate what program or affiliation you represent (Choose one):

• AmeriCorps State

• AmeriCorps VISTA

• AmeriCorps National

• CNCS Staff

• HandsOn Network Affiliate

• International

• Learn and Serve

• POLI/HON Staff

• Senior Corps (FGP/SCP/RSVP)

• State Commission

• None of the above

• Other (please specify below)

Program or Affiliation Other:

 How long have you been attending the NCVS?

• First Year

• 2 to 4 years

• 5 to 10 years

• 11 or more years

Did you attend the National Conference on Volunteering and Service in 2010, New York City?

• Yes

• No

 

If you attended the National Conference on Volunteering and Service in 2010, did you or your organization participate in the Days of Service and/or other activities listed below?

	Check all that apply.
	AmeriCorps Week
	Learn and Serve Challenge
	César Chávez Day
	Earth Day
	Family Volunteer Day
	International Volunteer Appreciation Day
	Join Hands Day
	Kids Care Week
	Make a Difference Day
	Martin Luther King Day of Service
	My Good Deed Day (One Days' Pay)
	National Volunteer Week
	National and Global Youth Service Day
	Service Summit and Day of Action
	Service Nation
	State Day of Service
	United We Serve/Summer of Service
	9/11 National Day of Remembrance and Service
	None of the above

How many years have you been involved in volunteering and service?  

• Less than 1 year

• 1 to 2 years

• 3 to 5 years

• 6 to 10 years

• More than 10 years

• I am not involved in volunteering and service

How would you rank your level of knowledge about volunteering and service?  

• Beginner

• Intermediate

• Advanced

• I am not knowledgeable about volunteering and service

Are you an AmeriCorps Alum?

• Yes

• No

If yes, select the program(s) based on your affiliation:

• AmeriCorps State

• AmeriCorps National

• AmeriCorps VISTA

• AmeriCorps NCCC

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