Form NRCS-Per-002 Volunteer Interest and Placement Summary

NRCS-PER-002
OMB No. 0578-0024

Earth Team Volunteer & Interest Placement
A. Name and Address:

A.1. Date:
A.2. Business Telephone Number:
A.3. Other Telephone Number:
A.4. E-mail Address:

B. Which general volunteer work categories are you most interested in?
Clerical Services

Conservation Education

Conservation Implementation

Conservation Planning & Technical Consultation

Operations Management (Financial & Human Resource)

Outreach & Communication

Research & Economic Assistance

Snow Survey

Soil Survey

Training

Other (please specify):
C. Highest Grade Completed:

C.1. Degree:

C.2. What skills/experience/education do you have that you would like to use in your volunteer work?
Clerical/Office Machines

Computer Programming

Drafting/Graphics

Driver’s License

Photography

Public Speaking

Sign Language

Supervision

Teaching

Working with People

Writing Editing

Other Skills (please specify):

D.1. Based on your selections in Sections B & C above, please describe what particular type of volunteer work you would like to do
(please describe any specific qualification, skills, experience or education that apply.)

Privacy Act Statement
This information is provided to comply with the Privacy Act (PL 93-579). U.S.C. 301 and 7 CFR 260 authorize acceptance of the information requested on this form.
The data will be used to contact applicants and interview, screen and select them for volunteer assignments. Furnishing this data is voluntary.
Public Burden Statement
In accordance with Privacy Act of 1974 (5USC 552a) and the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0578-0024.The
time required to complete this information collection is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection information.

NRCS-PER-002
OMB No. 0578-0024

City

E. What is your Area of Availability?

County

State

Other (please specify)

End Date:

E.1. Start Date:
E.2. How much time can you give?

hours per

E.3. What days are you available to volunteer:

Monday

Tuesday

Wednesday

Thursday

Friday

Other (Please specify):

F. Are you a United States Citizen? (check one box)

Yes

No

F.1. What type of documentation do you have stating that you are a Citizen or that you have legal entry in the U.S.?
(Please specify)
International volunteers (only) must complete the following section:
G. Contact Information (name, address, phone number, fax number, e-mail address) for your supervisor, major professor or another
individual that we may contact:

G.1. Planned dates for your visit: Arrival:

Departure:

G.2. Home Country:
G.3. Reason for visit to U.S.
G.4. Goals and objectives for volunteering:

If you do not have a visa, we recommend that you contact your Embassy and seek a visa that will allow you to do the kinds of things
you wish to do during your visit. Once obtained, we can continue with making arrangements. If your Embassy asks for a letter of
invitation, the USDA Natural Resources Conservation Service is prohibited from issuing letter of invitation. If you have any
questions regarding obtaining a visa and planning a visit with NRCS, please contact USDA-NRCS International Program Division at
(301) 504-2271.

USDA is an equal opportunity provider, employer, and lender