MHARV Volunteer Form
Thank you for your desire to volunteer with Mental Health America of Roanoke Valley.

Please only complete this form once you are sure you would like to volunteer with us, as it requests sensitive information to complete background checks such as your date of birth and social security number. Completion of this form provides permission for us to run a background check using the data provided should you request to work with our patients, children and families programing, or if you are providing any financial assistance. Please know your data will only be used for those purposes.

We are so appreciative of your wiliness to work with us. Please complete the entire form below, and a member of our staff will respond to you as soon as possible.

Email address *
First Name *
Your answer
Middle Initial *
Your answer
Last Name *
Your answer
Street Address (including City, State, Zip) *
Your answer
Contact Phone Number (including area code) *
Your answer
Email *
Your answer
Best Contact Method: Phone or Email
Your answer
Best Contact Time
Your answer
Date of Birth (This is required for background checks) *
MM
/
DD
/
YYYY
Social Security Number (This is required for background checks) *
Your answer
What position are you applying for? *
Required
Do you have access to transportation? *
Required
Which days of the week would you be available to volunteer with MHARV? *
Required
How many days of the week might you wish to volunteer with MHARV? *
What hours are you available for volunteering with MHARV? *
Required
Have you ever been convicted of a criminal offense *
If yes, please give date, nature of offense, city/state/country, and disposition
Your answer
Has your driver's license ever been suspended, revoked, or disqualified, or is it currently revoked, suspended or disqualified (including for medical purposes)? *
List previous volunteer experience
Your answer
What talents and skills are you willing to share to benefit Mental Health America of Roanoke Valley
Your answer
In an emergency, notify (name, address, phone number) *
Your answer
Submit
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