Volunteer Application

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Fill out the form below to be contacted for training and to become a certified volunteer.

Email *

Todays date: *

YYYY

Name (First and Last) *

Date of Birth *

YYYY

Physical Address *

Preferred Phone Number *

Are you a resident of Broome County (or able to drive to Broome County for training) *

Yes

Do you have reliable transportation *

Yes

Do you have regular computer and internet access? *

Yes

Do you receive text messages? *

Yes

Our next training will be held Saturday, August 29th and Sunday August 30th. These in-person hours are mandatory to attend and required by New York State Department of Health. Will you make every possible effort to attend? *

Yes, all sessions

Yes, most sessions

Not Sure

Which are you most Interested in? *

24 hour Crisis Line

Victim Advocacy (Medical)

Event Volunteer

Fundraising

Other:

Required

Why do you want to volunteer at CVAC *

What skills/life experiences do you have that may be an asset to our agency *

How did you learn about CVAC *

Reference (name and relationship) *

Reference Contact Information (phone and email) *

Reference (name and relationship)

Reference Contact Information (phone and email)

Have you ever been convicted of a felony *

Yes

If yes, please explain

A copy of your responses will be emailed to the address you provided.

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