Form Approved - OMB No. 0578-0024
U.S. Department of Agriculture Natural Resources Conservation Service THE EARTH TEAM Volunteer Interest and Placement Summary
A. Name and Address: A. 1. Date: A. 2. Business Telephone Number: A. 3. Home Telephone Number: B. Have You Ever Done Volunteer Work? (Check one box) B. 1. Where? B. 2. What Kind? C. Highest Academic Level Completed: (Check one box) Grades 1 College 1 C. 2. Major: D. Occupation: D. 1 Interest, Skills, Hobbies: 2 2 3 3 4 4 5 6 7 8 9 10 11 12 YES NO
NRCS-PER-002 Exp. 03-31-2006
C. 1. Degree:
D. 2. Special Training: E. What Type of Volunteer Work Would You Like to Do for Conservation? (Check boxes that apply) Outdoor Activity: Writing: Teaching: Computer: Public Speaking: Media Services: Clerical: E .1. Other, Specify: Photography:
F. What is Your Area of Availability? (Check one box) City: County: State:
F. 1. Date of Availability: Hourly:
F .2. How Much Time Can You Give? Weekly:
F. 3. Why Do You Want to Work for NRCS? G. Where Did You Learn About Earth Team Volunteers? (Check boxes that apply) TV: Radio: Newspaper: Friend: G .1. Other, Specify:
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 to interview, screen, and select them for volunteer assignments. Furnishing this data is voluntary. OMB Disclosure Statement According to 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 3 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.
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