Volunteer No.

:
Pender Office (28 West Pender St)

2011 Income Tax Clinic Volunteer Application Form

Salute Name
First Name Last Name

Age Group 16 – 19 20 – 24 25 – 34 35 - 44 45 – 54 55 - 64 Over 65

Address
No. Street City Postal Code

Contact

Home Phone Cell/Work Phone E-mail

Preferred Contact Method E-mail Phone Time of Contact
Emergency Contact

Phone No. Name Relationship

Native Language(s) Status Citizen Permanent Resident Others

How long have you been in Canada? Years Place of Origin

Education Elementary Secondary Post-secondary (please specify credentials)

Have you volunteered for any other Community Income Tax Clinic previously?
Current Occupation
No Yes Please specify: Year

Competency in filing a T-1 General Income Tax and Benefits Return manually
Advanced Higher Intermediate Lower Intermediate Beginner Don’t know how
Competency in filing a T-1 General Income Tax and Benefits Return electronically (using E-File or Net-File software)
Advanced Higher Intermediate Lower Intermediate Beginner Don’t know how
Knowledge of Canadian personal income tax
Complicated taxation Moderately complicated taxation Straightforward taxation Basic knowledge None

Trainings (Attendance is mandatory)

Volunteers accepted to the program are required to attend all the trainings and pay a $20 training deposit at the first training. Upon completion of
the trainings and fulfillment of at least 20 volunteer service hours, the training deposit will be fully returned.
Beginners’ (Saturday, February 19, 2011) Tutorial (Saturday, March 5, 2011)
Time: 9:00am – 4:00pm Time: Te Be Announced
Location: S.U.C.C.E.S.S. Social Service Centre – 28 West Pender Street, Vancouver, 604-684-1628

Availability (Please mark the shift(s) that you can take. We will provide a final schedule)
Week # Period Monday Wednesday Saturday
1pm – 5pm 1pm – 5pm 9am – 5pm (1 hour break)
1 Mar 14 - Mar 19 3/14 3/16 3/19 Extended Service
Saturday, April 30
2 Mar 21 - Mar 23 3/21 3/23 3/26
9am – 5pm
3 Mar 28 - Apr 2 3/28 3/30 4/2
★To Be Confirmed
4 Apr 4 – Apr 9 4/4 4/6 4/9
5 Apr 11 - Apr 16 4/11 4/13 4/16

I understand that the acceptance to be an Income Tax Clinic Volunteer will be at the discretion of S.U.C.C.E.S.S. and that false information on this
registration form may cause termination of volunteer service. I agree to adhere to the policies, rules and regulations of S.U.C.C.E.S.S. Volunteer
Service and I must keep clients’ information confidential.
Signature Date

For Office Use Only Training Deposit Receipt No.: Date: