IC Compassion Volunteer Application
*IC Compassion is required to share volunteers' and clients' information with AmeriCorps to comply with grant reporting requirements. Neither IC Compassion or AmeriCorps will share this information for any other purpose than to maintain internal compliance, and under no circumstances will any volunteer and client information be sold, in full or in part, to individuals, businesses, or other parties under any circumstances.
First and Last Name *
Your answer
E-mail Address
Your answer
Birthday *
MM
/
DD
/
YYYY
Phone Number *
Your answer
Street Address, City, State, Zip Code *
Your answer
Contact Preference
Languages Spoken
Your answer
Are you a licensed driver over the age of 18?
Are you interested in delivering donations or providing transport for clients?
Who referred you to IC Compassion?
Your answer
Volunteer Opportunities Desired? *
Required
Name of Reference *
Your answer
Reference Phone Number *
Your answer
May we contact your reference? *
When are you able to volunteer? *
Required
All personal information about clients of IC Compassion is privileged, confidential information and shall not be discussed with individuals outside of the agency. Confidential information about clients is restricted to employees and volunteers with proper authorization. Anything of a personal nature that can be directly linked to a specific client is confidential information about clients and shall be maintained only in designate files and shall be kept in locked storage areas or password protected computers when not in use. No confidential information about clients shall be shared with visitors, unauthorized volunteers, contractors, board members, donors, or persons outside the agency, either verbally or in writing, without proper written authorization. I agree to strictly adhere to the above confidentiality agreement and understand non-compliance may result in my termination of volunteer status. *
I do hereby consent that IC Compassion may take photographs or make video tapes of the above named individual and consent that IC Compassion may only use said images for training purposes or in promoting/publicizing the activities or work of IC Compassion. The consideration received by the undersigned for this consent is for the benefit that the above named individual may receive either directly or indirectly as a result of the reporting to promotion of the purposes of IC Compassion. *
I understand that all volunteers are run through both Iowa Courts Online and the National Sex Offender Registry. In addition, I may be asked to submit a background check for insurance purposes. This depends on the volunteer position that I am applying for and I am willing to comply with this policy if requested. *
Please type your full name below. By electronically signing your name below, you warrant the truthfulness of the information provided in this application. *
Your answer
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