Optional Form 301 – Fill Out and Use This PDF

OMB 0596-0080 (Expires 10/2010)

	Volunteer Application			Instructions:		Mark  in the appropriate			boxes,	for other
				items either		print or type	responses. If		extra	space is
	for Natural Resources Agencies
				needed use item 18.
	1. Name (Last, First, Middle)		2. Age		3. Telephone Number			4. Email Address
					( )	-

7. Which general volunteer work categories are you most interested in?

8. What qualifications/skills/experience/education do you have that you would like to use in your volunteer work?

9.Based on boxes checked in items 6 and 7, what particular type of volunteer work would you like to do? (Please describe any specific qualifications, skills, experience, or education that apply)

10. a. Have you volunteered before?

Yes

No

b. If Yes, please briefly describe your volunteer experience.

12.What are some of your objectives for working as a volunteer? (Optional)

13.Please specify any physical limitations that may influence your volunteer work activities:

Optional Form 301 (Revised 06/2007)

USDA-USDI

OMB 0596-0080 (Expires 08/2010)

15.Specify at least three states or specific locations within a state where you would like to do volunteer work.

16.Specify your lodging requirements:

I will furnish my own lodging (such as tent; camper; own, relative’s, or friend’s place)

I will require assistance in finding lodging

17.	If a volunteer assignment is not available at the location specified in item 15, do you want your application forwarded to
	another location, or Federal agency, seeking volunteers with your background/interest?
	Yes	No (Please specify)
18.	This is provided for more detailed responses. Please indicate the item numbers to which these responses apply:

BURDEN 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 0596-0080. The time required to complete this information collection is estimated to average 15 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 of information.

The U.S. Department of Agriculture (USDA) and U.S. Department of the Interior prohibit discrimination in all programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202- 720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA and USDI are equal opportunity providers and employers.

NOTICE TO VOLUNTEER

Volunteers are not considered Federal employees for any purposes other than tort claims and injury compensation. Volunteer service is not creditable for leave accrual or any other benefit. However, volunteer service is creditable work experience.

Privacy Act Statement

Collection and use is covered by Privacy Act System of Records OPM/GOVT-1 and USDA/OP-1, and is consistent with the provisions of 5 USC 552a (Privacy Act of 1974), which authorizes acceptance of the information requested on this form. The data will be used to maintain official records of volunteers of the USDA and USDI for the purposes of tort claims and injury compensation. Furnishing this data is voluntary, however if this form is incomplete, enrollment in the program cannot proceed.

2	Optional Form 301 (Revised 06/2007)
	USDA-USDI