Please complete this application form if you are interested in becoming a Howard Brown Health volunteer.

All HBHC Volunteers are required to:

* Be at least 18 years old.

**(Parental Consent for minors under 18 required!!**

* Complete a background check.(for certain roles)

* Attend a new volunteer orientation and any additional training that may be required for your position.

There is no specific commitment to be a Howard Brown Health Volunteer.

Once you complete the form, click the continue button at the bottom.

GENERAL INFORMATION:

First name:

Last name:

Middle name:

Preferred Name:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Primary Phone phone:

Email address:

Date of birth:

Age:

Gender:

Preferred Gender Pronoun:

Ethnicity:

How did you hear about us?:

Known Allergies:

EDUCATION:

Please list your highest level of education and school if relevant.

Highest Level of Education Completed:

School:

Area of Study:

VOLUNTEER POSITION OPTIONS:

Assignment Preference:

1st choice:

2nd choice:

3rd choice:

4th choice:

5th choice:

AVAILABILITY:

Please check the boxes below that represent your regularly available hours.

Morning: approx. 8am 1pm, Afternoon: approx. 1pm 6pm Evening: approx. 6pm- 10pm

WHY VOLUNTEER:

Have you previously VOLUNTEERED with us or been EMPLOYED by us? If not, why are you interested in volunteering with Howard Brown Health Center and the LGBTQ community? You must complete this section to be considered for the volunteer program.

PUBLIC INTERACTION:

Volunteering at Howard Brown Health Center is interactive. The main role of a HBHC volunteer is working with our visitors, staff and other volunteers. Please describe your experiences working with the public. You must complete this section to be considered for the volunteer program.

SKILLS & EXPERIENCE:

Check all boxes that apply.

EMERGENCY CONTACTS:

Please list two individuals we may contact in the event of an emergency.

1

2

First name:

Last name:

Relationship:

Primary phone:

AGREEMENT STATEMENT

I certify that the statements made in this volunteer application are true and correct, and have been given voluntarily. If the information provided in this

document is found to be untruthful, I understand that I will be released from the volunteer program. I understand that I will not be paid for my services as a volunteer, and that filling out an application for the program does not guarantee acceptance into a volunteer position.

I Agree