Volunteer Application Volunteer Application All information is Confidential within the Agency. Personal InformationName* First Last Home PhoneMobile PhoneEmail* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Emergency Contact* Emergency Contact Relationship* Are you fluent in any other languages besides English? Yes No If you selected Yes, what languages? Employment and Volunteer BackgroundDo you have any past volunteer history working in the DV field?* Yes No Select the options that apply to you I am applying to fulfill an internship or field practicum at the bachelor level. I am applying to fulfill an internship or field practicum at the master's level. None of the options apply to me. Education*Please select the last year completed. High School 9th Grade High School 10th Grade High School 11th Grade High School 12th Grade College Freshman College Sophomore College Junior College Senior Graduate School Name of School/College* Are You Presently Employed?* Yes No If you selected Yes for Employment:* Full-Time Part-Time Employed With:* Occupation* Please list any current or previous volunteer, internship or work experience:*Personal References*Please provide a minimum of three personal references. DO NOT LIST ANY DIRECT FAMILY MEMBERS (spouses OK). Close friends preferred to supervisors or professors who may not know you well.NamePhoneEmail Volunteer InterestsWhat are your volunteer interests?Check all that apply. *Requires 70 hour Training Course. Administrative (Reception, typing, data entry, etc.) Direct Service Intern (Must be a current college student in need of field education hours) Echo Thrift Boutique Fundraising Committees Helping with Mailings Helping with Special Events Hotline Volunteer* Presenting Programs (Public Speaking) and Community Outreach* Staffing Information Tables (explaining services, handing out brochures, etc.) Other If you selected Other, please describe: Have you volunteered at WRMC in the past? Yes No If you selected Yes, when? Do you have a Driver's License? Yes No If you selected Yes, when? Have you ever used our services? Yes No How did you hear about Safe Monroe, and what do you know about our programs and services?Why are you interested in volunteering with Safe Monroe?Share briefly your understanding of domestic violence.Special Skills, Training or TalentPlease list those things which you feel might benefit Women’s Resources or be helpful for us to know about you (i.e. bilingual, survivor of domestic violence, education). What attracted you to volunteering?What would you like to gain from volunteering?Is there anything else that you would like to tell us?Can you commit to the 70-hour training program to become a hotline or outreach volunteer, as well as a one year commitment of two overnight hotline shifts a month? (Hotline training class is free with one year volunteer commitment.) Yes No What days are you available?Check all that apply. Sunday Monday Tuesday Wednesday Thursday Friday Saturday What times are you available?Check all that apply. Monring Afternoon Evening Overnight Are you available regularly each week? Yes No NameI certify that the information provided above is true and correct and I give my permission to verify any of the information I have given above. Please type your name here to give us your consent. First Last EmailThis field is for validation purposes and should be left unchanged.