Date of Birth(mm/dd/yyyy):
Phone: Home/cell xxx-xxx-xxxx:
Emergency Contact Phone xxx-xxx-xxxx:
How did you hear about the volunteer opportunities at Harbor House?
What volunteer opportunities interest you most:
List activities you are presently involved in:
Please list other volunteer experiences (past or present):
Why do you want to volunteer for Harbor House Domestic Abuse Programs?
List years of schooling:
Please list degrees and major fields:
List any related courses or experience (volunteer or professional) which you feel would assit you in being a volunteer with this organization:
What languages do you speak and how comfortable are you with these languages?
Have you ever been arrested and/or convicted of a criminal offense?
If yes, specify the type of offense:
Please list three. Name/address/phone number xxx-xxx-xxxx/relationship
For Grant and statistics purposes only
American Indian/Alaskan Native
Native Hawaiian/Other Pacific Islander
American/Indian/Alaskan Native & White
Asian & White
Black/African American & White
American Indian/Alaskan Native & Black
If other Multi-Racial, please list:
Do you have a disability?
The primary purpose of the Harbor House Domestic Abuse Programs is to provide protection and safety to victims and the children of victims. The use or disclosure of any information by anyone affiliated with Harbor House (staff, volunteers, board members) that concerns the victims or the children of victims who receive services from Harbor House for any purpose is prohibited by state law. It is, therefore, a policy of the Harbor House Domestic Abuse Programs that any agent of Harbor House (staff, volunteers, board members) will treat all contacts and information regarding victims and children of victims who receive services from Harbor House as confidential. No information Regarding service recipients will be divulged either directly or indirectly to anyone.
CONFIDENTIALITY PLEDGE AND AGREEMENTS:
By clicking the submit button: