VOLUNTEER APPLICATION

Thank you for your interest in volunteering at Canopy Center.

The last four questions are optional information. Organizations that provide funding for our programs occasionally request demographic information about our volunteers. Answers to those questions would be helpful, but not required. Any information you provide in those questions will not be used to determine your suitability as a volunteer.
First Name:*
Middle:
Last Name:*
Birthdate:*
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RadDatePicker
Open the calendar popup.
E-Mail:*
Cell Phone:*
Other Phone:
Street Address:*
City:*
State/Province:*
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Zip/Postal Code:*
Employer/Occupation:
Emergency Contact:*
Emergency Contact Phone#:*
List any names you used in the past other than the one listed on this application:
If you have resided in any state besides WI in the past 5 years, please list them:
Volunteer Position Interests:*
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1. How did you hear about us?:*
2. If you have any experience relating to child abuse, please explain:*
3. Please describe any experience you have with severe stress or crisis:*
4. Describe any previous experience or training that relates to your desired volunteer position:*
5. What hobbies, interests, special talents or training can you bring to this position?:*
6. Please complete this sentence "When I think of an abusive parent I . . .:*
7. List any languages you speak other than English:*
8. What mode of transportation would most often be available to you?:*
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9. When are you available to start?:*
RadDatePicker
RadDatePicker
Open the calendar popup.
Please list three references (one professional) including email, phone #s and your relationship.:*
Your Gender:
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Your Age:
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Your Race/Ethnicity:
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Do you consider yourself to be "a person with disability"?:
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* REQUIRED FIELDS
By submitting this form, I authorize Canopy Center to proceed with a background check and to check my references (required of every staff member and volunteer). I certify that all of the above information is true and correct to the best of my knowledge.

Thank you for taking the time to complete this application!
Our volunteer coordinator will be contacting you soon.