Peer Volunteer / Peer Counselor Application
The Basics
Name: *
(first & last)
Preferred gender pronoun: *
(she, he, they, ze, etc.)
Phone Number: *
(with area code)
E-mail Address: *
Mailing Address: *
(Street, City, State, Zip)
Birth Date *
MM
/
DD
/
YYYY
Parent/Guardian Name: *
Parent/Guardian Phone Number: *
Scholastics
High School Grade *
School: *
Fluency in Languages besides English:
(if applicable)
Questions
1. How did you find out about Walker's Point Youth & Family Center? *
2. What interests you about this position? What kind of experience are you most interested in obtaining as a volunteer at Walker's Point Youth & Family Center? *
3. What is your past volunteer, service, and/or work experience? *
Please highlight leadership and relevant experience to this position, as applicable.
4. What are some of your interests, skills, extracurricular activities, hobbies, or anything else that you are passionate about or would like us to know? *
5. Please describe any special needs or accommodations:
Have you ever been convicted of a crime, or do you have any criminal charges pending against you? *
If yes, please describe:
In Case of Emergency
Please contact:
Name: *
Relationship to you: *
Phone number: *
Address: *
Availability
Please check all the times below during which you would be available to volunteer for a 3-4 hour weekly shift for at least a season (about 3 months). If the shift options below don't match exactly with your availability, please check the options that are closest to your actual availability.
Please remember to account for commuting time to our shelter location: 732 South 21st Street, Milwaukee, WI 53204.
Mondays *
Required
Tuesdays *
Required
Wednesdays *
Required
Thursdays *
Required
Fridays *
Required
Saturdays *
Required
Sundays *
Required
Scheduling Preferences
Please indicate any preferred shifts below (keeping in mind that one must be at least three hours)
1st choice (day and time):
2nd choice (day and time):
3rd choice (day and time):
Do you need to complete a certain number of hours by a specific date?
If yes, please indicate the number of hours and date by which they must be completed below.
Total number of hours:
Date by which they must be completed:
MM
/
DD
/
YYYY
Electronic Signatures
On occasion, audiovisual or other documentation of materials may be taken of activities sponsored by Walker’s Point Youth & Family Center. By typing my name below, I give Walker’s Point Youth & Family Center permission to use my name, likeness, image, voice, quotes, and/or appearance that may be embodied in any pictures, writings, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of Walker’s Point Youth & Family Center. *
By typing my name below, I certify that all information provided as a part of this application is true and correct without consequential omissions. I agree that Walker’s Point Youth & Family Center shall not be liable in any respect if my position is terminated because of false statements, answers, or omissions made by me in the information provided for this application. *
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