Volunteer Application Volunteer Application Personal Details and Contact Information arrowup1 First Name * Middle Name * Last Name * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Date of Birth * Email Address * Cell Phone * Home Phone * Employer Information arrowup1 Current Employer * Work Phone * Job Title and Duties: Why Hope Coalition arrowup1 Why do you want to volunteer for HOPE Coalition? Where are you most interested in volunteering? Haven of Hope Shelter Sexual Assault Services Kids Count Housing/Homeless Advocacy Administrative OtherOther Experience arrowup1 Have you volunteered in the past? If yes, where, and what did you do? What relevant experience, hobbies, skills do you have or that you’d most like to share? Please describe any experience you have working with people from diverse backgrounds, cultures, and economic groups. Availability arrowup1 What days are you available? Sundays Mondays Tuesdays Wednesdays Thursdays Fridays Saturdays Are you available to volunteer: Weekly Monthly Seasonally OtherOther Hours per day/week? Work Preferences arrowup1 Would you like to work with children? Yes No If so, what age groups? What type(s) of activities with children interest you? References arrowup1 Please list two references from employment, volunteer work, internships, etc. Reference One: Name Reference One: Phone Reference One: Email Reference One: Relationship Reference One: Address Reference One: Address Reference One: Address Reference One: Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Reference Two: Name Reference Two: Phone Reference Two: Email Reference Two: Relationship Reference Two: Address Reference Two: Address Reference Two: Address Reference Two: Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Emergency Contact Details arrowup1 Emergency Contact One: Name Emergency Contact One: Phone Emergency Contact One: Relationship Emergency Contact One: Address Emergency Contact One: Address Emergency Contact One: Address Emergency Contact One: Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Emergency Contact Two: Name Emergency Contact Two: Phone Emergency Contact Two: Relationship Emergency Contact Two: Address Emergency Contact Two: Address Emergency Contact Two: Address Emergency Contact Two: Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Physician’s Name Physician’s Phone Allergies: Vehicle Details arrowup1 Please list the following about the vehicle(s) that you may drive to HOPE Coalition: Vehicle One: Year Vehicle One: Make Vehicle One: Model Vehicle One: Color Vehicle One: License Plate Number Vehicle One: State Vehicle Two: Year Vehicle Two: Make Vehicle Two: Model Vehicle Two: Color Vehicle Two: License Plate Number Vehicle Two: State Captcha If you are human, leave this field blank. 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