Do You Need Help? Domestic Violence Violence Non-Violence Violence Phases Definition Battering Personality Safety Plan Rights Statistics Children Teen Dating Violence. Child Custody Frequently Asked Questions. Elder Abuse. Other Resources. Vintage Values. Our Newsletter Purple Ribbon Calendar of Events . Our Thanks Our Sponsors How You Can Help Tips For Parents Or Friends Of Victims Click Here If You Do Not Want Anyone To Know That You Have Visited This Website. About Us | Our Services | The Open Gate | Projects | Contact Us | Español | Latest News | Mission Volunteer Application This agency does not discriminate on the basis of race, color, religion, age, sex, national origin, political affiliation, sexual identity, or other non-performance factors. Your responses on the application are confidential. Name     Date of Birth Age(optional)     Sex: Male     Female Address City    State     Zip Home Phone     Work Phone Email Address Confirm Email Address Workplace Occupation Days And Hours Available To Volunteer: Hobbies Or Interest: How did you discover the opportunity to become an adovocate/volunteer: Below is a list of possible volunteer activities, please check the ones you would be interested in: Court advocacy     Office work     Resale shop     Board committees Fund raising     Speaker’s Bureau     Household maintenance Direct Services with women     Transportation     Children’s advocacy Other(specify): Past relevant experience: Purpose in volunteering: What qualities and skills do you have that you feel would contribute in this type of work: What are your feelings toward a woman who elects to remain in a violent situation: Often children from violent homes repeat behavior they have witnessed (i.e. verbal and physical abuse). Describe your reaction toward a child who may chose to repeat aggressive behaviors in your presence: Any comments or questions: Have you ever been convicted of a criminal offense: Yes     No If yes, state: Please list two (2) references (Name, Address, Relationship, Home/Work Phone): Reference #1 Reference #2 Who to contact in case of emergency (Name, Address, Relantionship, Home/Work Phone): Person #1 Person #2 I certify that the above statements are true and correct to the best of by knowledge and belief. I understand that willful misrepresentation or omission of facts may prevent my serving as a volunteer. I release all persons and agencies from any and all liability which may be incurred as a result of obtaining and using this information.

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