VOLUNTEER & BREAST HEALTH EDUCATORS APPLICATION

Full Name *

Address *

City *

State *

Postal code *

Email *

Phone *

Professional Degrees (MD, PhD, RN or other): *

Primary Language(s): *

Emergency Contact (Name, Relationship, Phone): *

VOLUNTEER INTERESTS: (Select all that interest you and provide any comments you wish) *

Advocacy: Legislative

Outreach: Health Fairs and Fundraisers

Speakers Bureau: Community Groups

Administration: Mailings, research, data entry

PERSONAL REFERENCES (students may use teachers and group leaders) - Include Name, Relationship, Address, City, State, Zip Code, Phone, Email Address for each reference: *

How did you hear about The Beautiful Gate (TBG)? *

How many hours per month/week do you wish to volunteer? Briefly explain why you want to volunteer at TBG: *

Are you currently employed? *

Yes

Are you currently a student?

Yes

If yes, what school are you attending and what is your degree program?

Do you have any relevant skills/experiences that would help?

Do you have past/other volunteer experience? If yes, where?

Please list volunteer experience:

Upload Resume Here *

I understand and fully acknowledge that, in volunteering for The Beautiful Gate, I am entering an AT WILL relationship and that this relationship can be terminated at any time by me or The Beautiful Gate for good cause, bad cause, or no cause at all.

I further understand that by signing this agreement, I give permission to contact my references or to conduct a criminal background check if deemed appropriate. It is my understanding that all information I have provided is true and complete to the best of my knowledge. I understand that giving false information can be grounds for immediate dismissal.

I understand that I may come in contact with sensitive information and that all information is confidential and is not to be repeated.

Volunteer Signature

Clear

I agree to terms & conditions provided by The Beautiful Gate Cancer Support & Resource Center. By providing my phone number and email, I agree to receive text and email messages from The Beautiful Gate Cancer Support & Resource Center.