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Agua Dulce
Akron
Alameda
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Albany
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Aromas
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Campbell
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Capitola
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Carmel Valley
Carmichael
Carson
Castro Valley
Castroville
Cave Creek
Cedar Park
Ceres
Chandler
Chester
Chestertown
Chicago
Chico
Chowchilla
Citrus Heights
Clearlake
Cloverdale
Clovis
Coarsegold
Coconut Creek
Coeur d'Alene
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Columbia
Concord
Copperopolis
Coralitos
Corcoran
Corona
Cotati
Cottage Grove
Cottonwood
Coyote
Crescent City
Crockett
Culver City
Cupertino
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Daly City
Danville
Davenport
Davis
Del Mar
Delhi
Denair
Denver
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Dos Palos
Dover
Downey
Dublin
Dunneville
Eagle Point
East Palo Alto
El Cajon
El Cerrito
El Dorado Hills
El Granada
El Monte
El Sobrante
Elk Grove
Emerald Hills
Emeryville
Encinitas
Eugene
Eureka
Exeter
Fair Oaks
Fairfield
Fayetteville
Federal Way
Felton
Fernly
Folsom
Forest Hill
Fort Mill
Foster City
Fountain Valley
Freedom
Fremont
French Camp
Fresno
Frisco
Fuquay Varina
Garden Grove
Gardena
Gilbert
Gilroy
Gladstone
Glen Cove
Gold River
Grand Rapids
Granite Bay
Grants Pass
Grass Valley
Greenbrae
Greenfield
Gustine
Half Moon Bay
Hamilton
Hanford
Haveford
Hayden Lake
Hayward
Healdsburg
Helena
Henderson
Hercules
Hidden Valley Lake
Hillsborough
Hillsdale
Hilton Head Island
Hollister
Honolulu
Houston
Huntington Beach
Huntington Beachj
Huntsville
Ione
Irvine
Island Park
Issaquah
Jacksonville
Kalispell
Kansas City
Kapaa
Kennewick
Kentfield
Keyes
Kihei
La Honda
La Jolla
La Mesa
La Mirada
La Quinta
La Selva Beach
Laconia
Lafayette
Laguna Beach
Lake City
Lake Havasu City
Lakeport
Lakeside
Lakewood
Larkspur
Las Vegas
Lawrence
Layton
Lenoir
Lexington
Lincoln
Little River
Littleton
Livermore
Livingston
Lockwood
Lodi
Long Beach
Los Altos
Los Altos Hills
Los Angeles
Los Banos
Los Gatos
Los Gatos`
Los Osos
Louisburg
Louisville
Lynden
Madera
Madison
Magalia
Manteca
Marina
Marina Del Rey
Marlborough
Martinez
Marysville
Mather
McClellan
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Medford
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Merced
Mesa
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Morro Bay
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Nevada City
New Brunswick
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Queen Creek
Raleigh
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Redmond
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Rialto
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Richmond
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Please give the name of three companies or non-profits where you have worked or volunteered. Please provide the associated dates and describe your role or responsibilities at each.
Do you have any of the following skill sets and experience:
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Friday      Morning
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VISTA CENTER VOLUNTEER AGREEMENT: I understand that Vista Center for the Blind and Visually Impaired may check my reference and/or criminal history record as part of their screening process and will maintain strict confidentiality of all information received. To the best of my knowledge, the information on this application is correct. I also understand that certain information about me will be discussed with the clients with whom I may work. If there are facts about myself that I do not want repeated, it is my responsibility to discuss them with a Vista Center staff member. I agree to maintain strict confidentiality in respecting the privacy rights of all direct and indirect participants with Vista Center for the Blind and Visually Impaired
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Please complete this application form to become a Vista Center Volunteer
2 of 3
3 of 3
First Name
Address 1
Address 1
City
Zip
Last Name
Select...
Agua Dulce
Akron
Alameda
Alamo
Albany
Alviso
American Canyon
Antelope
Antioch
Apple Valley
Applegate
Aptos
Arcata
Arnold
Aromas
Ashland
Atascadero
Atherton
Atwater
Auburn
Austin
Bakersfield
Banner
Banning
Bayside
Beach Park
Beaverton
Bellevue
Belmont
Ben Lomond
Bend
Benicia
Berkeley
Berlin
Beverly Hills
Billings
Bluffton
Boca Raton
Boise
Bonner
Boulder
Boulder Creek
Brentwood
Brisbane
Brookdale
Brookings
Burlingame
Calabasas
Caldwell
Cambridge
Cameron Park
Campbell
Camus
Canton
Capitola
Carlsbad
Carmel
Carmel Valley
Carmichael
Carson
Castro Valley
Castroville
Cave Creek
Cedar Park
Ceres
Chandler
Chester
Chestertown
Chicago
Chico
Chowchilla
Citrus Heights
Clearlake
Cloverdale
Clovis
Coarsegold
Coconut Creek
Coeur d'Alene
Colma
Columbia
Concord
Copperopolis
Coralitos
Corcoran
Corona
Cotati
Cottage Grove
Cottonwood
Coyote
Crescent City
Crockett
Culver City
Cupertino
Cuyahoga Falls
Daly City
Danville
Davenport
Davis
Del Mar
Delhi
Denair
Denver
Discovery Bay
Dos Palos
Dover
Downey
Dublin
Dunneville
Eagle Point
East Palo Alto
El Cajon
El Cerrito
El Dorado Hills
El Granada
El Monte
El Sobrante
Elk Grove
Emerald Hills
Emeryville
Encinitas
Eugene
Eureka
Exeter
Fair Oaks
Fairfield
Fayetteville
Federal Way
Felton
Fernly
Folsom
Forest Hill
Fort Mill
Foster City
Fountain Valley
Freedom
Fremont
French Camp
Fresno
Frisco
Fuquay Varina
Garden Grove
Gardena
Gilbert
Gilroy
Gladstone
Glen Cove
Gold River
Grand Rapids
Granite Bay
Grants Pass
Grass Valley
Greenbrae
Greenfield
Gustine
Half Moon Bay
Hamilton
Hanford
Haveford
Hayden Lake
Hayward
Healdsburg
Helena
Henderson
Hercules
Hidden Valley Lake
Hillsborough
Hillsdale
Hilton Head Island
Hollister
Honolulu
Houston
Huntington Beach
Huntington Beachj
Huntsville
Ione
Irvine
Island Park
Issaquah
Jacksonville
Kalispell
Kansas City
Kapaa
Kennewick
Kentfield
Keyes
Kihei
La Honda
La Jolla
La Mesa
La Mirada
La Quinta
La Selva Beach
Laconia
Lafayette
Laguna Beach
Lake City
Lake Havasu City
Lakeport
Lakeside
Lakewood
Larkspur
Las Vegas
Lawrence
Layton
Lenoir
Lexington
Lincoln
Little River
Littleton
Livermore
Livingston
Lockwood
Lodi
Long Beach
Los Altos
Los Altos Hills
Los Angeles
Los Banos
Los Gatos
Los Gatos`
Los Osos
Louisburg
Louisville
Lynden
Madera
Madison
Magalia
Manteca
Marina
Marina Del Rey
Marlborough
Martinez
Marysville
Mather
McClellan
McKinleyville
Medford
Menlo Park
Merced
Mesa
Mill Valley
Millbrae
Milpitas
Minneapolis
Miramar
Mission Viejo
Modesto
Monmouth
Monroe
Monrovia
Montara
Monte Sereno
Monterey
Montrose
Moraga
Morgan Hill
Morro Bay
Moss Beach
Moss Lake
Moss Landing
Mount Eden
Mount Hermon
Mountain House
Mountain View
Mukilteo
Murphys
Nacogdoches
Napa
Naples
Nevada City
New Brunswick
New York
Newark
Newman
Nipoma
North Highlands
North Las Vegas
Novato
Oakland
Ocean View
Omaha
Orange
Orangevale
Orem
Orinda
Oswego
Othertown
Oxnard
Pacific Grove
Pacifica
Pahrump
Paicines
Palm Desert
Palm Springs
Palo Alto
Paradise
Pasadena
Paso Robles
Patterson
Pebble Beach
Pescadero
Petaluma
Phoenix
Piedmont
Pinole
Pittsburg
Pittsburgh
Placerville
Plano
Pleasant Hill
Pleasanton
Portland
Portola Valley
Potomac
Providence
Prunedale
Puyallup
Queen Creek
Raleigh
Rancho Cordova
Rancho Mirage
Redding
Redmond
Redwood City
Redwood Estates
Redwood Shores
Reno
Rialto
Richland
Richmond
Richvale
Rio Vista
Ripon
Riverside
Rock Springs
Rocklin
Rohnert Park
Roseburg
Roseville
Royal Oaks
Sacramento
Salem
Salinas
Salt Lake City
San Anselmo
San Antonio
San Bruno
San Carlos
San Diego
San Francisco
San Gregorio
San Jose
San Juan Bautista
San Leandro
San Lorenzo
San Luis Obispo
San Martin
San Mateo
San Pablo
San Rafael
San Ramon
Sandy
Sanger
Santa Barbara
Santa Clara
Santa Clarita
Santa Cruz
Santa Fe
Santa Maria
Santa Rosa
Saratoga
Sausalito
Scotts Valley
Seaside
Seattle
Sebastopol
Sedona
Selma
Sequim
Shasta Lake
Sherman Oaks
Shreveport
Sierra City
Silmar
Silverdale
Simi Valley
Smithfield
Smithtown
Soda Springs
Soda Springs
Soledad
Somerset
Sometown
Sonoma
Sonora
Soquel
South Hadley
South Haven
South Lake Tahoe
South San Francisco
Sparks
Spokane
Springfield
St. George
Stanford
Stateline
Stockton
Suffolk
Suisun City
Suitland
Sunnyvale
Sunol
Tacoma
Tahoe City
Taylorsville
Templeton
Thousand Oaks
Tiburon
Tracy
Tres Pines
Tres Pinos
Tucson
Tulare
Turlock
Twain Harte
Tyson
Union City
Unknown
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Vallejo
Valley Springs
Van Nuys
Vancouver
Ventura
Victoria
Vinton
Visalia
Walnut
Walnut Creek
Washington Lake
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West Haven
West Point
West Sacramento
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First Name
Last Name
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Address 2
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Zip
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Work Phone
Select...
Agua Dulce
Akron
Alameda
Alamo
Albany
Alviso
American Canyon
Antelope
Antioch
Apple Valley
Applegate
Aptos
Arcata
Arnold
Aromas
Ashland
Atascadero
Atherton
Atwater
Auburn
Austin
Bakersfield
Banner
Banning
Bayside
Beach Park
Beaverton
Bellevue
Belmont
Ben Lomond
Bend
Benicia
Berkeley
Berlin
Beverly Hills
Billings
Bluffton
Boca Raton
Boise
Bonner
Boulder
Boulder Creek
Brentwood
Brisbane
Brookdale
Brookings
Burlingame
Calabasas
Caldwell
Cambridge
Cameron Park
Campbell
Camus
Canton
Capitola
Carlsbad
Carmel
Carmel Valley
Carmichael
Carson
Castro Valley
Castroville
Cave Creek
Cedar Park
Ceres
Chandler
Chester
Chestertown
Chicago
Chico
Chowchilla
Citrus Heights
Clearlake
Cloverdale
Clovis
Coarsegold
Coconut Creek
Coeur d'Alene
Colma
Columbia
Concord
Copperopolis
Coralitos
Corcoran
Corona
Cotati
Cottage Grove
Cottonwood
Coyote
Crescent City
Crockett
Culver City
Cupertino
Cuyahoga Falls
Daly City
Danville
Davenport
Davis
Del Mar
Delhi
Denair
Denver
Discovery Bay
Dos Palos
Dover
Downey
Dublin
Dunneville
Eagle Point
East Palo Alto
El Cajon
El Cerrito
El Dorado Hills
El Granada
El Monte
El Sobrante
Elk Grove
Emerald Hills
Emeryville
Encinitas
Eugene
Eureka
Exeter
Fair Oaks
Fairfield
Fayetteville
Federal Way
Felton
Fernly
Folsom
Forest Hill
Fort Mill
Foster City
Fountain Valley
Freedom
Fremont
French Camp
Fresno
Frisco
Fuquay Varina
Garden Grove
Gardena
Gilbert
Gilroy
Gladstone
Glen Cove
Gold River
Grand Rapids
Granite Bay
Grants Pass
Grass Valley
Greenbrae
Greenfield
Gustine
Half Moon Bay
Hamilton
Hanford
Haveford
Hayden Lake
Hayward
Healdsburg
Helena
Henderson
Hercules
Hidden Valley Lake
Hillsborough
Hillsdale
Hilton Head Island
Hollister
Honolulu
Houston
Huntington Beach
Huntington Beachj
Huntsville
Ione
Irvine
Island Park
Issaquah
Jacksonville
Kalispell
Kansas City
Kapaa
Kennewick
Kentfield
Keyes
Kihei
La Honda
La Jolla
La Mesa
La Mirada
La Quinta
La Selva Beach
Laconia
Lafayette
Laguna Beach
Lake City
Lake Havasu City
Lakeport
Lakeside
Lakewood
Larkspur
Las Vegas
Lawrence
Layton
Lenoir
Lexington
Lincoln
Little River
Littleton
Livermore
Livingston
Lockwood
Lodi
Long Beach
Los Altos
Los Altos Hills
Los Angeles
Los Banos
Los Gatos
Los Gatos`
Los Osos
Louisburg
Louisville
Lynden
Madera
Madison
Magalia
Manteca
Marina
Marina Del Rey
Marlborough
Martinez
Marysville
Mather
McClellan
McKinleyville
Medford
Menlo Park
Merced
Mesa
Mill Valley
Millbrae
Milpitas
Minneapolis
Miramar
Mission Viejo
Modesto
Monmouth
Monroe
Monrovia
Montara
Monte Sereno
Monterey
Montrose
Moraga
Morgan Hill
Morro Bay
Moss Beach
Moss Lake
Moss Landing
Mount Eden
Mount Hermon
Mountain House
Mountain View
Mukilteo
Murphys
Nacogdoches
Napa
Naples
Nevada City
New Brunswick
New York
Newark
Newman
Nipoma
North Highlands
North Las Vegas
Novato
Oakland
Ocean View
Omaha
Orange
Orangevale
Orem
Orinda
Oswego
Othertown
Oxnard
Pacific Grove
Pacifica
Pahrump
Paicines
Palm Desert
Palm Springs
Palo Alto
Paradise
Pasadena
Paso Robles
Patterson
Pebble Beach
Pescadero
Petaluma
Phoenix
Piedmont
Pinole
Pittsburg
Pittsburgh
Placerville
Plano
Pleasant Hill
Pleasanton
Portland
Portola Valley
Potomac
Providence
Prunedale
Puyallup
Queen Creek
Raleigh
Rancho Cordova
Rancho Mirage
Redding
Redmond
Redwood City
Redwood Estates
Redwood Shores
Reno
Rialto
Richland
Richmond
Richvale
Rio Vista
Ripon
Riverside
Rock Springs
Rocklin
Rohnert Park
Roseburg
Roseville
Royal Oaks
Sacramento
Salem
Salinas
Salt Lake City
San Anselmo
San Antonio
San Bruno
San Carlos
San Diego
San Francisco
San Gregorio
San Jose
San Juan Bautista
San Leandro
San Lorenzo
San Luis Obispo
San Martin
San Mateo
San Pablo
San Rafael
San Ramon
Sandy
Sanger
Santa Barbara
Santa Clara
Santa Clarita
Santa Cruz
Santa Fe
Santa Maria
Santa Rosa
Saratoga
Sausalito
Scotts Valley
Seaside
Seattle
Sebastopol
Sedona
Selma
Sequim
Shasta Lake
Sherman Oaks
Shreveport
Sierra City
Silmar
Silverdale
Simi Valley
Smithfield
Smithtown
Soda Springs
Soda Springs
Soledad
Somerset
Sometown
Sonoma
Sonora
Soquel
South Hadley
South Haven
South Lake Tahoe
South San Francisco
Sparks
Spokane
Springfield
St. George
Stanford
Stateline
Stockton
Suffolk
Suisun City
Suitland
Sunnyvale
Sunol
Tacoma
Tahoe City
Taylorsville
Templeton
Thousand Oaks
Tiburon
Tracy
Tres Pines
Tres Pinos
Tucson
Tulare
Turlock
Twain Harte
Tyson
Union City
Unknown
Vacaville
Vallejo
Valley Springs
Van Nuys
Vancouver
Ventura
Victoria
Vinton
Visalia
Walnut
Walnut Creek
Washington Lake
Washougal
Waterford
Watsonville
West Haven
West Point
West Sacramento
Westlake Village
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Wheatland
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Woodside
Yonkers
Yorkville
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Carrier must be selected if TextOK is checked
I do not smoke
I drive and have an insured vehicle
I have a valid picture ID
I use a screen reader
I use a screen magnifier
My professional license has been suspended
My professional license has never been suspended
I do not have a professional license
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North San Mateo County (Daly City-Millbrae)
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