601 E. Trade Street
Charlotte, NC 28202
Title of Respect
Is Mailing Address different from Residing Address?
Highest Level of Education
How frequently do you consume alcoholic beverages?
Have you ever tried, used or experimented with marijuana?
Have you ever tried, used, or experimented with heroin?
Have you ever tried, used, or experimented with cocaine?
Have you ever tried, used, or experimented with any other illegal substance?
Have you ever tried, used, or experimented with any other controlled substance that was not prescribed by a physician?
Have you ever tried or used a prescription medication prescribed for you when it was not medically necessary?
Have you ever served in the armed forces?
List three personal references who have known you for at least five (05) years. DO NOT INCLUDE RELATIVES.
Have you ever been arrested, detained or questioned by police concerning a crime?
Upload Attachment for Arrest of a Crime
Have your driving privileges ever been suspended, revoked or cancelled?
Upload Attachment for Driving Privileges
Have you ever received a traffic citation?
Upload Attachment for Traffic Citation
Have you ever committed a serious crime for which you were NOT arrested?
Upload Attachment for Serious Crime for which you were NOT arrested
Current Interests in the Volunteer Program includes [Choose as many as apply]