Volunteer Application
For Office Use: 1st Email 2nd Email Acuity Acuity: Scheduled BC PD
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Preferred Training Session: *
Personal Information
Name (First and Last): *
Primary Phone Number: *
Email: *
Birthday: *
MM
/
DD
/
YYYY
Mailing Address (Including City, State, and Zip Code): *
Physical Address (If different from mailing address.):
Information Relevant to Volunteering at Healing House
Educational Background (i.e., degree(s), major/minor, workshops, etc.): *
Work Experience (Please include relevant certification/licensing): *
Personal Experience: *
What interests you in volunteering at Healing House? *
Additional Information:
Emergency Contact
Emergency Contact's Name: *
Relation to Emergency Contact: *
Emergency Contact's Phone Number: *
References
Primary Reference's Name: *
Primary Reference's Phone Number: *
Primary Reference's Mailing Address: *
Secondary Reference's Name: *
Secondary Reference's Phone Number: *
Secondary Reference's Mailing Address: *
All volunteers must complete a criminal background check. This paperwork will be completed on the first day of training. Please bring $26, cash or check, to cover the processing fee for the criminal background check.
Thank you for expressing interest in volunteering at Healing House!
If you have additional questions or concerns, please call the office at 337-234-0443 or email us at program@healing-house.org
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