DCRC Volunteer Application

DCRC Volunteer Application
This agency does not discriminate on the basis of race, religion, age, gender, disability, national origin, political affiliation, sexual orientation, medical condition, or any other non-performance factor.

Requirements to volunteer:
- Complete all required training
- Commit to volunteer for at least one year, 4 shifts per month
- Have a high school diploma or equivalent
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of Birth

Month Day Year
Date
Gender
I am interested in:

Crisis Line Advocate Hospital Response Court Advocate Court Front Desk Office Volunteer Community Outreach Child Care Provider Thrift Store Volunteer
Volunteer in another capacity
Occupation/Employer
High School Graduation Date

Month Day Year
Date
How did you hear about DCRC?
Languages other than English
Expected Length of Volunteer Commitment
Past Relevant Experience, if any
What experience do you hope to gain through volunteering?
Do you have any personal experience with domestic violence / sexual violence?
Have you ever received DCRC Services?

Yes No
If so, when? (beginning-end dates)
Have you ever been arrested or convicted for a criminal offense, other than minor traffic violations?

Yes No
If yes, please explain.
Any additional comments or questions?
References

At least one must be a professional or academic reference.
Name

First Name Last Name
Phone Number

Area Code Phone Number
Name

First Name Last Name
Phone Number

Area Code Phone Number
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DCRC Volunteer Application

References

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