Welcome to Haitian Community Partners Services INC. (HCP).Our mission is to work in partnership with other organizations to advance and to integrate the underprivileged in the social and political development of their city through education, advocacy, lobbying, and service. We are delighted you have chosen to become part of our community. All information on this application will be treated with strict confidence. New members must pay an entrance fee of US$50. Full time student must submit the proper document to waive the fee.
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1. Personal Information:

Last Name: ______First Name: ______Home Address: ______City: ______

State: ______Zip Code: ______Phone: ______

Email: ______

2. Education

School / Name of School or Course of Study / High level completed / Currently Attending
High School
College/University
Graduate school
Special Training or Skills Received

3. Employment History

Current Employment Status:  Full-Time  Part-Time  Student  Retired  Unemployed

4. Please indicate the skills and experience you would bring to your volunteer role:

 organizational skills  experience with children  teaching skills  public speaking  civic education  Health care/medical  Legal/law  blogging  board experience  web site  political  Account/Business  Presentation skill  Lobbying  Microsoft office  Social network  communications skill  adult tour guide  computer technology  Literacy education

5. Sharing Personal Information

My contact information may be shared with Political Campaigns  No  Yes

My contact information may be shared with local businesses  No  Yes

Signature of Applicant ______Date ______

I would like to become a member of Haitian Community Partners services, INC. (HCP), and have filled out this application completely and accurately. I am submitting dues of $50 (annually) along with my application and agree that this information will held on my record for as long as I am a member. I will also follow the mission statement and bylaws passed by the organization which I have read. Please call our office at (508) 588-0400 if you have any questions at all or need assistance in filling out this application.