• Your Name:

• Your Email:

• Your Cell Phone:

• Your Day Phone:

• Your Evening Phone:

• Your Address-1:

• Your Address-2:

• City:

• State:

• Zip Code:

• Your Occupation: *

• Your Employer: **

• Emergency Contact Name: **

• Emergency Contact Phone: **

• If under 18 years of age, please list your Date of Birth:
  * If under 18, please see “Parental Permission” section below now.

• Do You Want a Regular On-going,Short-term, or One-time Assignment?: On-going Short-term One-time

• Are You Interested in Volunteering to Fulfill a... Class Assignment Court-Mandated Community Service Other Project Requirement I Just Want to Help

• Special Skills Development/Fundraising Computer/Web Design Skills Direct Services Other Interests and Skills No Answer

• If this is for a school internship, please provide the name of the school and advisor name and contact information:
  

• Do you have a degree or certification for the volunteer/Intern position in which you are applying?
  Yes
  No

• How do you feel about working with homeless people?
  

• What do you hope to gain from your experience at HHCLA?
  

• How many hours per week do you want to volunteer/intern and for what period of time?
  

• Which day(s) and Times(s) Are You Available to Volunteer On?:
  MORNINGS
  Monday Morning (9am-12pm)
  Tuesday Morning (9am-12pm)
  Wednesday Morning (9am-12pm)
  Thursday Morning (9am-12pm)
  Friday Morning (9am-12pm)
  
  AFTERNOONS
  Monday Afternoon (12-5pm)
  Tuesday Afternoon (12-5pm)
  Wednesday Afternoon (12-5pm)
  Thursday Afternoon (12-5pm)
  Friday Afternoon (12-5pm)
  

• What skills, training, or knowledge do you have that will assist in volunteering/interning?
  

• Please check the kind of volunteer/intern work you would be willing to do to benefit HHCLA:
  Answering Phones
  Greeting Visitors
  Data Entry/Word Processing
  Curriculum Development/Training
  Grantwriting
  Copying
  Filing

• General Office (other):
  

• Please check which department you would like to volunteer in:
  Development/Fundraising
  ITP (integrated Treatment Program)
  CASC (Community Assessment Service Center
  AHH (Access to Health and Housing)
  Needle Exchange/HAW Program
  Administration/Training and Education
  Vendome

• Have you ever been convicted of a crime?
  Yes
  No

• If you have been convicted of a crime, please explain:
  

• Message/Comment:
  

Please read the following carefully before “accepting” or “declining” the terms of this agreement:
I (whose name is listed above) understand that this is an application for and not a commitment or promise of volunteer/intern opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer/intern position and in interviews with HHCLA that is true, correct, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer/intern position. I understand that information contained on my application will be verified by HHCLA. I understand that a background check through the Universal may be run before I begin my volunteer/intern service with HHCLA. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a position with HHCLA or my termination as a volunteer/intern.

• Accept
  Decline

Volunteer Orientation RSVP:
Before you can begin volunteering with HHCLA, you’ll need to attend our next scheduled Volunteer Orientation Day (VOD). (See top of page). Please indicate “yes” if you will be at the next VOD, or “no” if you will not be at the next VOD.

• Yes. I'll be there!
  No. I won't be there.

Parental Permission (If under 18 years of age)
If you are under the age of 18, you will need to download this form and have it completed and signed by your parent or legal guardian, and returned to us by fax or mail.