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I understand that any intentional false or misleading information provided may be grounds for dismissal. Printed name of applicant If under the age of 18 Signature of applicant Date 220 South Mecklenburg Avenue South Hill VA 23970 434 262-4170 Phone 434 262-4174 Fax ljordan colonialcenterva.org. Before selecting your preferred volunteer opportunities below you should review volunteer requirements to ensure your eligibility. D. O. B. SSN -- Name Date Address Phone Home City State Zip Work...

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