NAME ________________________________________________

ADDRESS _____________________________________________

_____________________________________________

PHONE# (HOME)_________________ (CELL) _____________

EMAIL ADDRESS ___________________________________

DATE OF BIRTH: ________________________

PRIOR VOLUNTEER EXPERIENCE:

AVAILABILITY

_____ Ongoing* _____ Sporadic _____ Per Project

_____ *hours per week, estimated

AREAS OF INTEREST

Would you most like to:

_____ Perform various TASKS on a volunteer basis for H.E.A.L.

_____ Participate on an ongoing Committee of the H.E.A.L. Board

_____ Join the H.E.A.L. Board of Directors

VOLUNTEER TASKS (Check one or more that interest you)

_____ Office work (answering phones, data entry, filing, other)

_____ Outreach (newsletter, direct mail, public speaking)

_____ Organizational (develop procedures, programs)

_____ Transportation (driving a victim to/from legal or medical)

_____ Tutor or Mentor (life skills, resume development)

_____ Food Service (menu planning, grocery shopping)

_____ Maintenance (housecleaning, gardening)

_____ Recreational (craft program, exercise program)

_____ Health & Beauty (massage, hair style, manicures, facials)

_____ Childcare (game planning, after school recreation)

OTHER (Please describe)_________________________________________________________________
___________________________________

VOLUNTEER COMMITTEES OF THE H.E.A.L. BOARD

Members of the community are welcomed to work directly with H.E.A.L. Board members by participating in Board Committees.
Please check one, if interested in becoming a member of a H.E.A.L. Committee:

_____ By-laws (review agency by-laws and recommend changes)

_____ Education & Programs (Speakers Bureau, work with other community organizations that will educate the community on DV)

_____ Architecture, Design and Building (design, construct, renovate, finish and furnish The Nest shelter and offices)

_____ Finance (developing budgets, bookkeeping and/or accounting of agency’s revenues and expenses)

_____ Development/Fundraising (Adopt a Room, Membership, grant proposals, garage sales, special events)

VOLUNTEER SIGNATURE & DATE
____________________________ _____________

If you have any questions about this form, or about volunteering for H.E.A.L., please call Juanice Battin at 505.258.9089