Please complete this application form if you are interested in becoming a Grassroots Crisis Intervention Center volunteer. Proof of COVID vaccination and the date of a recent flu shot are required. Masks and temperature scans are required for entry. The minimum age to volunteer is 15 years and some positions require individuals 18 or 21 years and over. Once you complete the form, click the Continue button at the bottom.

Contact Information

Volunteering Experience

Skills & Talents


Please indicate the days and times you are usually available to volunteer.

Community service hours

If you are volunteering for community service hours please include the name of the organization the hours will be reported to.

Additional Background Information

Please note that background checks are required for adults working with children and other positions involving client information.

Emergency Contact

Please list two emergency contacts in the event of an emergency.

Parent/Guardian Authorization

I Agree

I understand and agree that submitting this application form does not automatically register me as a Grassroots Crisis Intervention Center volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
By submitting this form, I attest that the information I have provided on the form is true and accurate.