Host Application for Hattie's House
Hattie's House volunteer application form to host San Diego area patients and families in need
Email address *
Full Name *
Your answer
Phone Number *
Your answer
Phone Type *
Preferred Method Of Contact *
Address Information *
Street
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
How did you find out about us ? ( please be specific as possible *
Your answer
Why are you interested in volunteering with Hattie's House *
Your answer
Please provide a description of the space you have available in your home to potentially host a Hattie's House guest *
Your answer
Person 1 Relationship to Main Contact *
Your answer
Would Person 1 be actively involved in hosting? *
Person 2 Name *
Your answer
Person 2 relationship to Main Contact *
Your answer
Would person 2 be actively involved in hosting? *
If there are additional household members, please provide the same information for any additional household occupants: *
Your answer
Occupation(s) of adult(s) in household *
Your answer
Employer(s) of adult(s) in household *
Your answer
Main Contact Work Schedule *
Work schedule of other adult(s) who be be actively involved in hosting ( if applicable) *
If "other" or you would like to provide additional information about your schedule describe here: *
Your answer
High School(s) attended
Your answer
College(s) attended:
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Please briefly describe your volunteer experiences, in any, including organization and role. *
Your answer
Have you every hosted individuals or families in your home before? If so, please provide a short description of the program and your involvement. *
Your answer
Do you speak any languages beside English? If so, which languages and to what proficiency? *
Your answer
Have you ever been convicted of a felony? *
If Yes, please give date(s) and explain *
Your answer
Have any household members ever been convicted of a misdemeanor, besides traffic violations? *
If Yes please give date(s) and explain *
Your answer
Acknowledgement and Certification I hereby certify, by typing my name in the box provided below, that the information that I have provided on this application is truthful, complete, and accurate to the best of my knowledge.I acknowledge that completing this application does not form a contract between myself and the Hattie’s House and does not guaranteed that I will be excepted for participation in the program.
Your answer
Electronic Signature *
Your answer
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