Contact Information

Name

Age

Address

Ethnicity

School You Attend

E-Mail Address

Availability

During which hours are you available for volunteer assignments?

Weekday mornings

Weekend mornings

Weekday afternoons

Weekend afternoons

Weekday evenings

Weekend evenings

Interests

Tell us in which areas you are interested in volunteering

Administration

Events

Field work

Fundraising

Deliveries

Phone bank

Newsletter production

Volunteer coordination

What do you know about Destiny House?

Do you have previous experience?

Summarize your experience in the areas of Domestic/Teen Dating Violence? HIV and other STI’s? Teen Pregnancy? Substance Abuse? Gang Violence? Or any other issues involving youth?

What skills do you believe you will bring to Destiny House?

Summarize special skills and qualifications you have acquired from employment, previous volunteer work, or through other activities, including hobbies or sports.

What ideas do you have for making teen programs, in this community more effective?

What do you bring to this organization?

Provide an example of a time when you have demonstrated leadership or organization skills?  What was easy for you?  What was difficult?

Do you see any problems or challenges with working with other youth?

How would you address any problems or difficulties working with other youth?

Destiny House works in very close quarters, much of the work is done outside in the community, i.e. street outreach, facilitation of workshops for younger adults, going to the library to do research, etc.  Therefore it is imperative that the person employed be honest, committed, hard-working and trustworthy.  Otherwise, it is important that you understand that you could face termination on site.  Do you have a clear understanding of the above?  How do you feel about it? (please answer on next page)

Provide any information about yourself.

Person to Notify in Case of Emergency

Name

Street Address

City ST ZIP Code

Home Phone

Work Phone

E-Mail Address

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Name (printed)

Signature

Date