Volunteer Application
For Office Use: 1st Email 2nd Email Acuity Acuity: Scheduled BC PD
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Preferred Training Session:
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Session 1: Friday, January 7, 2022 (8:30 AM - 3:30 PM) and Saturday, January 8, 2022 (8:30 AM - 1:30 PM)
Session 2: Tuesday, June 7, 2022 (5:30 PM - 9:00 PM), Thursday, June 9, 2022 (5:30 PM - 9:00 PM), and Saturday, June 11, 2022 (8:30 AM - 1:30 PM)
Session 3: Friday, September 16, 2022 (8:30 AM - 3:30 PM) and Saturday, September 17, 2022 (8:30 AM - 1:30 PM)
Personal Information
Name (First and Last):
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Your answer
Primary Phone Number:
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Your answer
Email:
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Your answer
Birthday:
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MM
/
DD
/
YYYY
Mailing Address (Including City, State, and Zip Code):
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Your answer
Physical Address (If different from mailing address.):
Your answer
Information Relevant to Volunteering at Healing House
Educational Background (i.e., degree(s), major/minor, workshops, etc.):
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Your answer
Work Experience (Please include relevant certification/licensing):
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Your answer
Personal Experience:
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Your answer
What interests you in volunteering at Healing House?
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Your answer
Additional Information:
Your answer
Emergency Contact
Emergency Contact's Name:
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Your answer
Relation to Emergency Contact:
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Your answer
Emergency Contact's Phone Number:
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Your answer
References
Primary Reference's Name:
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Your answer
Primary Reference's Phone Number:
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Your answer
Primary Reference's Mailing Address:
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Your answer
Secondary Reference's Name:
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Your answer
Secondary Reference's Phone Number:
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Your answer
Secondary Reference's Mailing Address:
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Your answer
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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