HEART Program Volunteer Application; Out in the Open 

Thank you for your interest in Volunteering with Out in the Open's HEART (Health Equity and Access for Rural TLGBQ+) Program. Please take a minute to fill out this quick questionnaire and we will be in touch to schedule a call where we can get into the more nitty gritty details of volunteering with the HEART program! The information gathered here will not be shared with anyone outside of OITO staff.

The HEART Program aims to address common healthcare barriers faced by TLGBQ+ people in Windham County, and the Northeast Kingdom of Vermont. A team of trained volunteers work alongside community members to expand access to safe and supportive healthcare. By filling out this form you are expressing your interest in becoming a volunteer with the HEART Program. If you would like to request support from the HEART Program, follow this link.

If it is not possible for you to fill out this form, or you need assistance filling out this form, please contact Frank Osten or Noa Isabella, our Health Justice Organizers. 

Frank Osten
frank@weareoutintheopen.org
(802) 289-0921

Noa Isabella
noa@weareoutintheopen.org
(802) 289 0092
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Name and Pronouns *
Ex: Alex (they/them) or Lashawn (she/her) or Matt (he/him)
What language(s) do you primarily use? *
Where in VT are you located? *
Volunteers may need to physically accompany community members to appointments so it is important to be in either Windham County, the Northeast Kingdom, or close by. 
Email *
This will be used to contact you and not shared with anyone else.
Phone Number *
This will be used to contact you and not shared with anyone else.
Do you have reliable transportation? *
If you do not have reliable transportation, that is ok, and there are still ways for you to support community members through the program! Volunteers may need to physically accompany and/or drive community members to appointments so it is important for us to know if you are able to do this. 

When our Health Justice Organizers meet with you, we can assess your capacity for providing transportation, even if you answer yes to this question. 
Do you identify as part of the TLGBQ+ (Trans, Lesbian, Gay, Bisexual, Queer) Community? *
Are you fully vaccinated for COVID-19? *
Are you over 18 years of age? *
What is your availability like?
This gives us a rough idea of when you might able to be supporting community members. We understand schedules fluctuate a lot, and we can circle back with you directly to get a better idea of your scheduling needs.
7-8 am
9-11 am
12 pm
1-4 pm
5-8pm
8-10 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Which of the following do you feel interested in doing? Please share in the "other" section additional ideas you have around supporting folks! *
Required
Which of the following do you feel you cannot support community members with. Please share in the "other" section if you have other things that are hard limits for you, that you are aware of at this time.  *
We understand your capacity may shift, and this is just to get us an idea of where you are at right now. 
Required
How did you hear about the HEART Program?
Would you like to be added to the Out in the Open newsletter?
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Thank you for taking the time to fill out this form! Our Health Justice Organizers, Frank Osten and Noa Isabella, will be in touch with you soon to follow up. Would you prefer a text, a call, or an Email? *
Please leave any other comments you have here. :)
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