Matrix LifeCare Volunteer Application
Thank you for your interest in volunteering with Matrix LifeCare Center.

Please fill out the application form below, and someone will reach out to you within 5 business days (please note holiday hours and closings for trainings may add time to this).

We are thankful for you taking the time to fill this out.

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Todays Date *
First Name *
Last Name *
Date of Birth *
Phone number *
Email *
Address *
City *
State *
Zip Code *
Matrix LifeCare Center exists to provide education, support, and resources that empower individuals to make life-affirming decisions before, during, and after pregnancy.                                                                                At Matrix LifeCare Center we believe that all people, from conception to natural death, are made in the image and likeness of God, making each life a priceless gift that deserves to be protected and loved.  We are a non-profit organization dedicated to promoting the dignity of every human life and to empowering the Lafayette community to do the same by providing support, education, and resources to women and families in need. *
Do you consider yourself pro-life or pro-choice? *
Please expand on the previous answer. *
Why do you want to volunteer at Matrix? *
Is this application for a possible internship at Matrix? *
Employer/Job title
Do you have any  special licenses, certifications or medical credentials? Please list. *
Do you speak any languages other than English? If so, please specify which languages. *
Please post which hours you are available within our regular office hours- Regular office hours are: Mon 9-5, Tues 12-7, Wed 9-5, Thurs 9-5 and Fri 9-3. *
How did you hear about Matrix LifeCare Center? *
Have you ever volunteered at Matrix LifeCare Center or any other Pregnancy Resource Center before? What was your volunteer role there? *
Do you have a criminal background? If yes, please explain. *
Have your ever had a Child Protective Services case? If yes, please explain. *
Are you comfortable providing virtual care? *
References: please list 3 references, their relationship to you, their phone numbers and their email address. *
Please click on the following link, which provides more information on our Mission, who we are, and the commitments involved with each volunteer opportunity. After reading the document, please select one of the options below. *
After reading the document from the previous question, please check all of the area(s) you are interested in volunteering. Please note: you may choose more than one, and this does NOT commit you to anything. *
By submitting this form, I attest that I have read and agree to the following:
I understand and agree that submitting this application form does not automatically register me as a Matrix LifeCare Center volunteer, and that there may be certain qualifications I must meet, including the acceptance of established policies and procedures before I may begin volunteering.
By submitting this form, I attest that the information I have provided on the form is true and accurate.  

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