RefugeeRISE Member Information
✅This form is designed to help the RefugeeRISE Staff gather some information about you. Normally these are questions we need to gather, but are difficult to acquire while people are getting started.
✅Not all questions are required and will say so on the form. For example, personal questions about your family and educational background are optional. They are asked because they help us understand what services to offer our program and show the diversity of RefugeeRISE.
Email address *
First Name - as it appears on a gov't ID *
Your answer
Last Name - as appears on a gov't ID *
Your answer
Service email , if different from above
Your answer
What languages do you speak? *
Your answer
What is your country of origin?
You are not required to answer this question. We only gather this information to show the diversity of our program. If you feel uncomfortable sharing please skip.
Your answer
Did you move to serve in this program? If so where from?
Your answer
Where do you live?
You are not required to answer this question. We only gather this information to allow us to better serve our members. If you feel uncomfortable sharing please skip.
What is your education level?
You are not required to answer this question. We only gather this information to show the diversity of our program. If you feel uncomfortable sharing please skip.
Are currently taking classes or working? *
Yes, Fulltime
Yes, partime
I want to work or go to school
No
Are you currently taking classes? (HS/College)
Do you currently have outside employment?
Are you BOTH in school and have outside work?
Do you have children?
You are not required to answer this question. We only gather this information to show the diversity of our program and for us to understand what services we need to provide for members. If you feel uncomfortable sharing, please skip.
Health Insurance and Public Assistance
Yes
No, I already use it
No, I do not want to use it
I want more information
Do you plan to use AmeriCorps Childcare?
Do you plan to use AmeriCorps Insurance?
Do you plan to apply for food assistance?
Do you have any dietary restrictions? *
What is your favorite candy or snack? *
Your answer
What is your t-shirt size? *
Each member will get a RefugeeRISE AmeriCorps Tshirt. 1 per member only
Emergency Contact Name *
Your answer
Emergency Contact Phone number *
Your answer
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