Poverty
Services
Catholic Charities of Southern Illinois
Catholic Diocese of Belleville
Diocesan Pastoral Center
2620 Lebanon Ave.
Belleville, IL 62221
Phone Janet at (618)526-7203 Fax (618)526-2974
Volunteer No.
State Agency
Referral No.
Application For Child Care
Advocate (Volunteer)
Last Name
First Name
Middle
Name
Address
Age
Sex
City
State
Zip Code
County
IL
Parish/Church
Home Phone
Work Phone
Yes
No
Do you have Internet
Access?
Please explain any special
requirements or circumstances that should be considered