Volunteer at Shelterhouse!

Please complete the form below and click submit at the bottom. All fields with (*) need to be completed.

Full Name (*)

Please type your full name.
E-mail (*)

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Former Names

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Date of Birth (*)

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Phone Number (*)

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Street Address (*)

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City (*)

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State (*)

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Zip Code (*)

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Place of Employment (*)

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Schools Attended (*)

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Mileage from your home to Shelterhouse (*)

Please tell us how many miles it takes to drive to Shelterhouse from your home.
Have you ever been a client at Shelterhouse? (*)
YesNo
Have you been our client?
Do you have any previous volunteer experience (*)
YesNo
Have you ever volunteered?
If yes, where did you volunteer?

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Do you take any drugs (prescription or non-) that may affect your working ability? (*)
YesNo
Are you taking drugs?
If yes, please describe.

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Have you ever been convicted of a crime? (*)
YesNo
Have you been convicted of a crime?
If yes, please explain.

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How did you learn about Shelterhouse? (*)

Please tell us how you heard about us.
Have you had any experience dealing with sexual or domestic violence? (*)
YesNo
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If yes, explain briefly.

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Volunteer hours preferred (days and times). (*)

When would you like to volunteer?

Please include 3 references.

Name of Reference #1 (*)

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Telephone Number for Reference #1 (*)

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Email Address for Reference #1 (*)

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Address for Reference #1 (street, city, state) (*)

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Name of Reference #2 (*)

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Telephone Number for Reference #2 (*)

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Email Address for Reference #2 (*)

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Address for Reference #2 (street, city, state) (*)

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Name of Reference #3 (*)

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Telephone Number for Reference #3 (*)

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Email Address for Reference #3 (*)

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Address for Reference #3 (street, city, state) (*)

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Which of the following are you interested in volunteering to help with? (Mark yes for activities you are interested in. Mark no for activites you do not wish to volunteer for.)

Child Care (Age 16+): Provide childcare during client meetings by playing with and supervising children and preparing snacks. Respite childcare during evenings or weekends.
YesNo
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Overnight Client Advocate (Age 18+): Spend 1 or 2 nights a month sleeping over. Respond to any calls and situations that arise at the shelter or the crisis line. Staff on-call is always available.
YesNo
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Transportation (Age 18+): Transport clients to appointments (medical, legal, etc.) or to do errands (bank, post office, etc.).
YesNo
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Girls on the Run: Help with running / character-building prevention program with pre-teen girls as coach, assistant coach or running buddy.
YesNo
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Organization, Cleaning & Maintenance: Perform house and ground maintenance (paint, weed, trim bushes, rake yard, etc.) Help organize new donations, as well as donations already at Shelterhouse.
YesNo
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Event Planning: Take a leadership role with special events such as Rock the Tridge, Lunafest women’s film festival, Sexual Assault or Domestic Violence Awareness Months.
YesNo
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Community Outreach: Staff community booths, distribute agency information and help with various awareness activities. Help at special events such as Rock the Tridge, Kids Day at the mall or educational workshops.
YesNo
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Hospital Response (Age 18+): Respond to the hospital to provide sexual assault victims and their families with information and support (training provided through the sexual assault program).
YesNo
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Clerical Assistance / Crisis Phone (Age 18+): Answer telephones, assist with client and shelter needs.
YesNo
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Friends for the Journey (Age 21+): Are you a compassionate, caring woman at a place in your life where you can support someone else with time, friendship and fun? If so, consider being a mentor in our Friends for the Journey program. The commitment is once weekly for 1-2 hours. Training and ongoing support is provided.
YesNo
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Court Watch (Age 18+): Observe hearings and trials in the Midland County courthouse and complete simple written report for Shelterhouse staff. Training is provided. Must be available during the day on weekdays. Number of hours varies.
YesNo
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Other: If you want to volunteer with something not listed above, please type it below.

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INFORMED CONSENT: I authorize the Council on Domestic Violence and Sexual Assault (Shelterhouse) to conduct a background check for the sole purpose of determining whether I am an appropriate candidate to be a volunteer. This authorization shall expire one year from the date of my signature. (*)
YesNo
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