Volunteer Application

First Name*

Middle Name

Last Name*

Nick Name

Street 1*

Street 2

City*

State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWisconsinWyoming

Zip*

Home phone

Work phone

Cell phone

Email*

If you would like to volunteer as a family with minor children, please list the children’s full names and birthdates

Date of Birth*

Gender Identity
FemaleGender QueerIntersexNonbinaryMaleTransgender FemaleTransgender MaleOther/Prefer to self-describePrefer not to share

Preferred Gender PronounShe/her/hersHe/him/hisThey/them/theirsInterchangeableNo Pronoun/Name onlyOther

EthnicityAfrican American or BlackAsianHispanic or LatinxMultiracialNative AmericanOtherPacific IslanderWhitePrefer not to describe

How did you hear about us?

Highest level of EducationHigh School/GEDSome collegeAssociates degreeTrade/vocational/technical college,Bachelors degreeMasters DegreeDoctoral degree

Name of School

Area(s) of Study:

Name of Previous Employer*

Employer Address 1*

Employer Address 2*

City*

State*
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWisconsinWyoming

Employer Work Phone*

Please indicate Duties/Primary Responsibilities at Employer 1*

Name of Previous Employer 2*

Employer 2 Address 1*

Employer 2 Address 2*

City*

State*
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWisconsinWyoming

Employer 2 Work Phone*

Ok To Call?*YesNo

Please indicate Duties/Primary Responsibilities at Employer 2*

Please let us know how you would like to volunteer at OUT HEALTH. Check all that apply:

Administrative/Clerical DutiesData entryEvents planning, coordinating, staffingFundraisingResearch/writingWebsite/social mediaWorking with LGTBQ+ youth individuals/groups/programsWorking with LGBTQ+ adult individuals/groups/programsOther Interests

Please check any and all that represent your typically available/preferred hours to volunteer (mornings are generally 8:00 - 1:00 pm, afternoons are generally 1:00 – 5:00 pm evenings are generally 5:00 - 9:00pm):

Please provide a brief statement in your interest in volunteering for OUT HEALTH INC and supporting the LBGTQ+ community.

First Name*

Last Name*

Relationship to Prospective Volunteer*

Email*

Primary Contact Phone Number*

First Name*

Last Name*

Relationship to Prospective Volunteer*

Email*

Primary Contact Phone Number*

First Name*

Last Name*

Relationship to Prospective Volunteer*

Email*

Primary Contact Phone Number*

First Name*

Last Name*

Street 1*

Street 2

City*

State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWisconsinWyoming

Zip*

Home Phone*

Work Phone*

Cell Phone*

Relationship*

Email*

First Name

Last Name

Street 1

Street 2

City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWisconsinWyoming

Zip

Home Phone

Work Phone

Cell Phone

Relationship

Email

Please let us know if there are any special circumstances or medical information we might need to know about you which may present risk during an emergency (i.e. allergies, heart conditions, medications you are taking, etc.).

If you wish to volunteer to satisfy a community service requirement, please let us know who the service is required by (school, court-order, etc.), how many hours you need to complete, when the service must be completed, and name/email/phone number of the contact person is to whom we should certify your service completion hours.