ContractVolunteer Service Agreement • January 25th, 2013
Contract Type FiledJanuary 25th, 2013VOLUNTEER SERVICE AGREEMENT—NATURAL & CULTURAL RESOURCES 1. INDIVIDUAL 2. GROUP 3. NAME OF AGENCY Ridgefield National Wildlife Refuge 4. AGREEMENT # 5. NAME OF VOLUNTEER (First, Last) 6. U.S. CITIZEN OR PERMANENT RESIDENT YesNo, list visa type 7. NAME OF GROUP 8. NAME OF GROUP CONTACT (First, Last) 9. STREET ADDRESS 10. CITY, STATE, ZIP CODE 11. EMAIL ADDRESS 12. PHONEHome: Mobile: 13. AGEUnder 15 15 ‐ 1826 ‐ 35 36 ‐ 54 19 ‐ 2555 and Older 14. ETHNICITY & RACE (Optional): Please report both ethnicity and race and tell us if you are a veteran or have a disability. Multiracial respondents may select two or more races. This information will inform our understanding of diversity and inclusion among the volunteer force in the natural and cultural resource areas. 14a. Ethnicity (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Paci