Peer Volunteer / Peer Counselor Application
The Basics
Name
(first & last)
Your answer
Preferred gender pronoun
(she, he, they, ze, etc.)
Your answer
Phone Number
(with area code)
Your answer
E-mail Address
Your answer
Mailing Address
(Street, City, State, Zip)
Your answer
Birth Date
MM
/
DD
/
YYYY
Parent/Guardian Name
Your answer
Parent/Guardian Phone Number
Your answer
Scholastics
High School Grade
School
Your answer
Fluency in Languages besides English
Your answer
Questions
1. How did you find out about Walker's Point Youth & Family Center?
Your answer
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?
Your answer
3. What is your past volunteer, service, and/or work experience?
Please highlight leadership and relevant experience to this position, as applicable.
Your answer
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?
Your answer
5. Please describe any special needs or accommodations:
Your answer
Have you ever been convicted of a crime, or do you have any criminal charges pending against you?
If yes, please describe:
Your answer
In Case of Emergency
Please contact:
Name:
Your answer
Relationship to you:
Your answer
Phone number:
Your answer
Address:
Your answer
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):
Your answer
2nd choice (day and time):
Your answer
3rd choice (day and time):
Your answer
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:
Your answer
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.
Your answer
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.
Your answer
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