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Information & Registration |
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My Healing Place Volunteer Application
Date of Application: _______________________
Name: _______________________________ Telephone #: ___________________
Mailing Address:
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Alternate Phone #: _________________________________________
Who should be contacted in case of an emergency?
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Emergency Contact Phone #:
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Date of Birth: _____________________________________________
What kind of volunteer work do you wish to do at My Healing Place? Please check the appropriate box.
___ clerical, office work ___children’s group facilitation
___ hospitality/welcoming ___adolescent’s group facilitation
___ fundraising ___adult group facilitation
___special group projects ___ Other, Please explain ____________
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How did you find out about My Healing Place? ____________________________________
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Have you done volunteer work in the past? ___________ If yes, please describe your previous work as a volunteer (include for whom you volunteered and what you did).
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___________________________________________________________________________ (If more space is needed please feel free to use the back of this paper)
If no, what has drawn you to volunteer at this particular time? _________________________
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Since MY HEALING PLACE focuses on grief, loss, and trauma, volunteers, particularly those who facilitate support groups, must be aware of their own loss history and how this may impact work as a volunteer.
Have you experienced any recent losses? ________
If yes, when did this loss occur? _________________
Please explain the nature of your loss.
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If you have not experienced recent losses, were there any losses in the past that impacted you? Please explain: _____________________________________________________________
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My Healing Place requires three (3) letters of personal recommendation for all volunteers. Please list the names and contact information for the three persons whom you will ask to write a letter for you. Letters of recommendation should be sent directly to: My Healing Place – 1406 Camp Craft Rd. Ste. 200, Austin 78746 Attn: Volunteer Coor.
1.______________________________________________________________________
2.______________________________________________________________________
3.______________________________________________________________________
My Healing Place Volunteer Consent for Background Check
Date _______________________
I give my consent for authorized staff of MY HEALING PLACE to request a criminal background check on me as a required part of my volunteer services to the center. I understand that all information received in this criminal background check report will be held confidential.
Further I understand that any report of a felony on my criminal background check may result in my inability to serve as a volunteer at MY HEALING PLACE.
____________________________ ______________________________ Printed Name of Volunteer Signature of Volunteer |
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