Healing Broken Vessels : Become an HBV Volunteer

Consent for storing submitted data *

Yes, I give permission to store and process my data

Last Name *

Applicant Last Name

First Name *

Applicant First Name

Address 1 *

Applicant mailing address

Address2

Applicant mailing address 2

City *

Applicant mailing city

State *

Applicant mailing state

Contact Phone *

Applicant main contact phone number

Contact Email *

Applicant main contact email address

How did you hear about Healing Broken Vessels? *

Are You a Christian?

Yes

Are You Currently Employed?

Yes

Highest Degree Attained *

Major

Institution

Are You Currently Attending School

Yes

Certifications and Expiration Dates

(e.g. CPR, First Aid)

What does our mission statement mean to you?

Languages Spoken

Have you ever been convicted of a felony or a misdemeanor?

Yes

We value our volunteer teams and understand you are the lifeblood of our success in carrying out our mission. The women who visit us need you and many times the center is their only hope to stay motivated. Do you understand the importance of your volunteer commitments? *

Yes

Please state your availability Monday through Saturday *

What skills are you willing to share as a volunteer for Healing Broken Vessels?

Summarize any special skills and qualifications you have acquired from employment, previous volunteering, activities, including hobbies and sports

Do you have any health issues or limitations that HBV/Board members should know?

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Address 1 *

Emergency Contact Address 2

Emergency Contact Phone Number *

By submitting this application, I affirm that the facts set forth in it are true and complete. I authorize Healing Broken Vessels, Inc. to verify any information relevant to my suitability as a volunteer. I understand, if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal from any volunteer assignment. *

Full Name for Agreement *

Become an HBV Volunteer

Volunteer with Us

Our Address

Volunteering at HBV

Volunteer Application Form

(takes approximately 15 minutes to fill out)

Applicant Contact Information