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Client Advocate Volunteer Application

Please note:

  • All information in this application is kept strictly confidential and used only to match volunteers with available opportunities.
  • Please print or type carefully and answer each question as completely as possible.
  • If you have questions about completing this this form, call the Hotline Manager at 301-662-8800.
  • Completion of this application does not guarantee acceptance to the Heartly House volunteer program.

Mr.Ms.Other










PhoneEmail



Emergency Contact Information

In case of an emergency involving you, whom should we contact?






Professional Experience

Please begin with your most recent position and include any job related volunteer assignment







Education and Skills

Please respond for each level of education that you have completed.





















yesno




Sentence Completion






References

Heartly House may conduct background checks on all volunteer applicants. Use this space for any references we should contact, particularly if you do not have any work related references. You may want to include instructors, counselors or advisors, coworkers, and leaders of civic or professional groups. Please do not include relatives or friends.

Reference #1





Reference #2





Reference #3





Availability and Interest



Please check all times that you may be available to volunteer at Heartly House.


8- 12pm9- 1pm10- 2pm11- 3pm12- 4pm1- 5pm2- 6pm3- 7pm4- 8pm5- 9pm6- 10pm

8- 12pm9- 1pm10- 2pm11- 3pm12- 4pm1- 5pm2- 6pm3- 7pm4- 8pm5- 9pm6- 10pm

8- 12pm9- 1pm10- 2pm11- 3pm12- 4pm1- 5pm2- 6pm3- 7pm4- 8pm5- 9pm6- 10pm

8- 12pm9- 1pm10- 2pm11- 3pm12- 4pm1- 5pm2- 6pm3- 7pm4- 8pm5- 9pm6- 10pm

8- 12pm9- 1pm10- 2pm11- 3pm12- 4pm1- 5pm2- 6pm3- 7pm4- 8pm5- 9pm6- 10pm

8- 12pm9- 1pm10- 2pm11- 3pm12- 4pm1- 5pm2- 6pm3- 7pm4- 8pm5- 9pm6- 10pm

Volunteer Commitment

Please read carefully, sign, and date below.

  • I certify that the information given herein is accurate and complete to the best ofmy knowledge.
  • I authorize Heartly House, Inc. to investigate all statements in this application asmay be necessary to determine appropriate volunteer placement.
  • For the well being of our clients, volunteers and staff, it is important that our
    volunteers are committed to the Heartly House mission statement and our domestic violence and sexual assault philosophies.
  • Opportunities for volunteers are provided without regard to race, color, creed, religion, ancestry, national origin, sex, sexual orientation, disability, age, marital status.
  • Heartly House is not obligated to accept you as a volunteer, nor or you obligated to accept a volunteer position if offered.



Thank you for taking the time to fill out this application completely and honestly. Upon receipt and processing of this form, someone from Heartly House will contact you.

Thank you for supporting Heartly House, Inc.

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