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Volunteer Application Form

    Name

    Address

    Email

    Home phone

    Work phone

    Date of Birth

    I check my email:
    DailyWeeklyRarely

    How did you hear about us?
    FriendNewspaperTelevisionBrochure or PamphletRadioSpeakerFlyerOther

    Other:

    Please record your recent employment and/or volunteer experience:

    Employer:
    Position:
    Dates:
    Phone:
    Employer:
    Position:
    Dates:
    Phone:
    Employer:
    Position:
    Dates:
    Phone:

    Share briefly your understanding of domestic violence.

    What are your reasons for wanting to volunteer with DVIP?

    If your volunteer service will fulfill a class requirement please list the class name, goal of
    your service and how many hours you must complete.

    If you are volunteering to fulfill a community service requirement, please state your offense and the
    number of hours you must complete.

    Have you ever been arrested?
    YesNo

    Please explain:

    Have you been suspected or convicted of child abuse?
    YesNo

    Please explain:

    Please check the areas you have interest in:
    Office SupportTransportationFundraisingCrisis HotlinePeer CounselingLegal AdvocacyMaintenanceEvent PlanningInterpretation/TranslationYouth ActivitiesOther

    If other:

    Please check the areas you have experience in:
    Office SupportVictim ServicesCounselingEvents PlanningComputerAdvocacyYouth ServicesPublic SpeakingBuilding Repair and MaintenanceFundraisingGrant Writing

    Today's date:

    Please sign here:

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