Online Enrollment

Important - When your enrollment form has been received by Border Community SERVICE, you will receive an acknowledgement. If you do not receive an acknowledgement, please contact the office to ensure that your enrollment has been received. Please complete all sections.

Your Information

Name *

Address *

City *

Zip *

Home Phone

Cell Phone

Business Phone

Email *

Date of Birth *

Gender*

Male
Female

How did you learn about Border Community SERVICE at NU?

Physical/Medical Limitations

Primary Emergency Contact

Name *

Phone #1

Phone #2

Secondary Emergency Contact

Name

Phone #1

Phone #2

As a volunteer for Border Community SERVICE you will be automatically covered by volunteer insurance coverage. Please provide the following information.

Beneficiary

Beneficiary for Volunteer Supplemental Accident Insurance.

Name *

Relationship *

Address *

City *

Zip *

Phone *

CERT Class

I acknowledge that by participating in this training, I am making a commitment to provide volunteer services through Border Community SERVICE.

Signature *

Date *

Is fire hot or cold? Spam Question *

Undergraduate

Graduate

Ph.D.

Other

Border Community Service

Online Enrollment

Border Community Service

Your Information

Primary Emergency Contact

Secondary Emergency Contact

Beneficiary

CERT Class