Interested in volunteering/interning? Please fill out the following application.

We are currently accepting volunteer applications for our Welcome Crew in the following locations:

New Haven, CT
Providence, RI
Stamford, CT

Contact Information

Legal first name:

Legal last name:

Street 1:

City:

State:

Zip:

Cell phone:

Other phone:

Email address:

Education

Student Status:

Highest Degree Earned:

Current School (If Attending):

Will you receive educational credits?:

Yes

Please list course requirements if receiving school credit for volunteering.

School Contact

First name:

Last name:

Title:

Work phone:

Email address:

Types of volunteer opportunities

Choose the one(s) that best describe your interest.

Number of Hours You Would Like to Serve:

Frequency:

Volunteer Interests:

Escort/Welcoming patients

Internship Interests:

Research Study Coordinator

Clinic Locations

Choose the clinic location(s) that you prefer.

Location Preference:

1st choice:

2nd choice:

3rd choice:

Emergency Contact

First name:

Last name:

Cell phone:

CERTIFICATIONS AND AGREEMENTS

The information provided within this application and any attachments will be used to consider my qualifications to provide voluntary, unpaid services to Planned Parenthood of Southern New England, Inc. (PPSNE). I understand that completing this application does not guarantee that I will be offered a voluntary position with PPSNE.

I hereby authorize PPSNE, its subsidiaries and affiliates, employees and authorized representatives, to make inquiry of and request information from any individuals, present and former employers or volunteer supervisors, schools and colleges, credit institutions, criminal investigation bureaus, professional licensing organizations, and any of the entities that may possess information concerning me or that may be custodians of records relating to me. I also authorize the above-subscribed sources to release all information requested, and I hereby release those sources from any liability for doing so.

I understand that with regard to investigative consumer reports, I have the right within a reasonable period of time, to request in writing the nature and scope of the investigation requested by PPSNE or its agents, along with a written summary of my rights under the Fair Credit Reporting Act.

I certify that all statements made by me on this application and all related application documents are true, complete, and correct to the best of my knowledge. I understand that any misleading or incorrect statements may be cause for denial or ending of my volunteer/internship services and that PPSNE shall not be liable in any respect if my volunteer/internship services are denied or ended because of false, misleading, or incorrect statements, answers, or omissions made by me on this application.

I hereby release PPSNE, its agents and representatives, from any and all claims related to the receipt or use of information in regard to my volunteer/internship application.

In the event that I enter into a volunteer/internship agreement with PPSNE, I agree to comply with all its rules, regulations, and directives. I understand that my volunteer/internship services are not for stated term and are subject to the provisions within the PPSNE Volunteer/Internship Handbook.

All qualified candidates will be considered for placement without regard to race, creed, color, national origin, ancestry, sex, age, marital status, sexual orientation, veteran status, or disability.

I Agree