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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:

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