About Shanti | Donate | Volunteer

Shanti Volunteer application

*** Please print and fax to 415-674-0370 ***

Personal info

Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Email address:

Your Birth date/Age:

Emergency contact name:

Address:

Phone(s):

Relationship to you:

Employment and Education Information

Job title:

Employer:

Field of study:

School:

Languages

Language(s) Spoken:

Chinese
English
French

Spanish
Other

Languages Read:

Chinese
English
French

Spanish
Other

Optional information

Gender Identity:

Female Male Transgender/of Trans Experience

Sexual Orientation/Sexual Affection:

Racial and/or Ethnic Identification:

General Application Information

Have you ever applied to be a Shanti volunteer?

Yes No

If yes, when and for what program?

How did you hear about volunteer opportunities at Shanti?

Craigslist
Friend
Shanti Staff

Shanti Web Site
Other

Availability (check all that apply):

Weekdays	Weekends
Mornings Afternoon Evenings	Mornings Afternoons Evenings

How many hours per week are you able to volunteer?

hours

Describe briefly why you are interested in the Shanti volunteer program, what you hope to gain, as well as contribute.

Describe your current or previous volunteer experience(s).

Are you in a recovery program?

No Yes If yes, how long?

Do you have any personal health concerns that might impact your work as a volunteer (i.e., chronic illness, allergies)?

Yes No

Our clients, staff, and volunteers come from many different backgrounds. They may include people of different ethnicities, genders, or sexual orientations, people who are active or recovering drug/alcohol users, or people altered by illness. How might you be challenged working with people who have different life experiences from your own?

AGENCY SUPPORT VOLUNTEER APPLICANTS ONLY

Desired Volunteer Position (check all that apply)?

Administration
Client Activities Desk
Client Workshops
Fundraising

Outreach
Other

How long can you volunteer?

Desired start and end dates?

PEER SUPPORT VOLUNTEER APPLICANTS ONLY

Do you have a (check all that apply):

car
truck

driver’s license
automobile insurance

Desired Volunteer Position (Check all that apply)?

Peer Support Client Match
Drop-In Center Peer Support
On-Call Peer Support

HIV Services
LifeLines Breast Cancer
Undecided

Are you able to make at least a 6-month commitment to the Peer Support Program?

Yes No

Can you commit to attending a once-a-month support group on M, T, W, or Th, 7-9 p.m?

Yes No

Describe any major life changes you’ve experienced in the past 12 months (entering a recovery program, loss, ill health, relocation/move, job, relationship, etc.).

What are some of your other personal and/or professional obligations (e.g., family, primary care provider, and/or religious commitments)?

How has serious illness affected your life? (You do not need to have experience with serious illness to become a Shanti Volunteer.

Reference

Name:

Phone(s):

Years Acquainted:

May we call this person?

Yes No

Volunteer today!

About Shanti | Donate | Volunteer

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