Please complete this application form if you are interested in becoming a Catholic Charities of the Diocese of La Crosse volunteer. We are currently looking for volunteers who can dedicate full days and a week of their time to helping out at Fort McCoy. Once you complete the form, click the Continue button at the bottom.


Name and address


Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.



Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email. However, we will not send you any email if you prefer not to receive. Use the check boxes below to select the kinds of email you would like to receive from us.



Emergency Contact

Please provide a name and phone number for us to contact in case of an emergency.



Previous Volunteer or Work Experience

Briefly describe your previous volunteer and work experience.



Special Skills/talents/areas of expertise


Group or School you are volunteering through

If possible, please provide the name and address of the group or school.



Availability

List days and times that you would be available to volunteer.



Confidentiality Statement

CONFIDENTIALITY PLEDGE

PROTECTED CLIENT INFORMATION

I, the undersigned, have read and understand Catholic Charities of the Diocese of La Crosse, Inc's (CCDL) policy on the protection of confidential client information as described in the organization’s Notice of Information Practices. This policy is in accordance with relevant state and federal legislation, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), CFR Title 45, Public Welfare and Human Services.

I also acknowledge that I am aware of and understand the corporate policies of CCDL regarding the confidentiality of protected client information including the policies relating to the use, collection, disclosure, storage and destruction of protected client information.

I understand that unauthorized use or disclosure of such information will result in a disciplinary action up to and including termination of employment and/or a report to my professional regulatory body, school or temporary agency (if applicable).

I also understand that intentional disclosure or unlawful use of such information may result in civil or criminal liability for myself or CCDL pursuant to relevant State and Federal legislation.

I understand that my obligations to protect client information, in terms of disclosure, will continue after my employment or volunteering with CCDL ends.



Ethics Policy

Approved by Board of Directors 03/17/2021

Ethics Pledge

169.00 CONFORMANCE WITH CODE OF ETHICS & CANNON LAW

All professional employees, independent contractors, paid consultants, volunteers, board members and members of any subsidiary boards, committees, commissions, or advisory bodies shall adhere to the Code of Ethics of Catholic Charities, U.S.A. and the Code of Canon Law of 1983 as it impacts their canonical responsibilities in carrying out the mission of Catholic Charities of the Diocese of La Crosse, Inc.

I. Introduction and Intent

It is the intent of Catholic Charities of the Diocese of La Crosse, Inc. to abide by the highest professional and ethical standards. The policy set forth below is to be considered an integral part of that effort. This policy supplements but does not supplant the Code of Ethics of Catholic Charities, U.S.A. which was adopted by the Board of Directors of Catholic Charities of the Diocese of La Crosse as its official Code of Ethics. Both documents should be adhered to and considered in light of the mission of Catholic Charities of the Diocese of La Crosse, Inc.

All professional employees, independent contractors, paid consultants, volunteers, board members and members of any subsidiary boards, committees, commissions, or advisory bodies:

1. Are prohibited from having a direct or indirect interest in the assets or leases of Catholic Charities of the Diocese of La Crosse, Inc.

2. Shall not receive any compensation for their service on such boards, committees, commissions or advisory bodies except for reasonable reimbursement for costs actually incurred in attending meetings of the same.

3. Shall not receive any preference in the application for or receipt of the services provided by Catholic Charities of the Diocese of La Crosse, Inc.

4. Shall not receive or retain any compensation for the referral of consumers, clients, volunteers, or program participants to another provider of services. Nor shall they pay any other service provider for the privilege of receiving a referral to any of the programs or services offered by Catholic Charities of the Diocese of La Crosse, Inc. This policy shall not prohibit Catholic Charities of the Diocese of La Crosse, Inc. from receiving funding from the United Way or other organization which may sponsor other social service agencies or referral lines such as First Call For Help.

5. Shall not steer or direct referrals of any consumers, clients, volunteers, or program participants or applicants to a private practice in which employees, independent contractors, or paid consultants of Catholic Charities of the Diocese of La Crosse, Inc. or their immediate family members, meaning parents, spouse, or children, have a direct financial interest. They shall not steer or direct referrals for those who are more costly to serve to other agencies or practitioners. Clients who are easier or less costly to serve will not be given any preference by Catholic Charities of the Diocese of La Crosse.

6. Shall not personally accept anything of value in return for the provision of services within the scope of their duties at Catholic Charities of the Diocese of La Crosse, Inc.

7. Shall not conduct any private practice for compensation on any premises owned, rented or leased by Catholic Charities of the Diocese of La Crosse, Inc. nor use any materials, office supplies, or business machines owned, rented or leased by Catholic Charities of the Diocese of La Crosse, Inc. in furtherance of the same.

8. Shall adhere to the professional standards governing their profession by rule of law or governing body.  Examples of such rules include the Rules of Professional Conduct of Attorneys, the U.S. Bishop’s Ethical and Religious Directives on Health Care and Standards of Practice of the American Nurses Association and the National Association of Social Workers.

9. Shall adhere to the Code of Ethics of Catholic Charities, U.S.A. and the Code of Canon Law of 1983 as it impacts their canonical responsibilities in carrying out the mission of Catholic Charities of the Diocese of La Crosse, Inc.