NHA Staff: Please note that this form contains CONFIDENTIAL PERSONAL information. Please return in a sealed envelope within 24 hours to the Resource Development department for processing
Volunteer Position Applying for:
Name:
Date:
Would you be willing to allow our agency to run a criminal history check? Yes or No
*If unwilling to undergo a check, you may be limited in your potential volunteer placement options.
Address:
City, State and Zip:
E-mail Address:
Are you over 18 years old? Yes or No
Home Phone:
Work Phone:
Employer/School:
Occupation:
Contact in Case of Emergency:
Phone:
Days available: Sun, Mon, Tues, Wed, Thurs, Fri, Sat
Hours available:
Gender Identity: Female, Male, Transgender Woman (MTF), Transgender Man (FTM), Nonbinary/Genderqueer, Prefer not to answer
Ethnicity: Caucasian, African American, Asian, Native, Latino, Native Hawaiian/Pacific Islander, Prefer Not to Answer
Are you a member of any other minority group/community that will inform or strengthen your service with NHA? If so, please feel free to list here.
(We will use this information for statistical purposes and to provide you with support as a volunteer only.)
Do you speak or write any other languages in addition to English? Yes or No
If yes, which languages:
I hereby acknowledge that everything I have disclosed on this document is true to the best of my knowledge. I understand that I will be working with Northwest Housing Alternatives personnel as a volunteer. I will not hold the organization or any member of the staff responsible for accident or injury caused by my own actions.
Signature:
Date:
(A designated adult must sign for minors)
