ACS Mid-Central Florida E-Newsletter LGFB Application | Page 3

NCA-LOOK GOOD…FEEL BETTER FACILITATOR/VOLUTNEER COSMETOLOGIST APPLICATION Dear Volunteer: You have been recommended as an American Cancer Society LG…FB Volunteer Cosmetologist. Please complete this Volunteer Profile and return it to your American Cancer Society Patient Service Manager. Thank you VOLUNTEER PROFILE (Please print): Name: Home Address: City, State, Zip Code: Place of Employment: Work Address: City, State, Zip Code: Unit Name: Area: Home Phone: Work Phone: Fax: Email: EDUCATION: Beauty Professionals: Please provide information on your cosmetology, esthetics/makeup artistry, or nail technician training (name of educational institution, specific studies, and date of licensing). Volunteer or Site Coordinators: Please provide information on your high school or college level education (name of educational institution, focus of study, degree granted, date of graduation). Revised: 6/3/04