Volunteer/Intern Application
Submit to: YWCA South Hampton Roads
Attn: Marissa L. Bond, Outreach & Volunteer
5215 Colley Avenue, Norfolk VA 23508
757-625-4248, ext 30 (Office) 757-625-1946 (Fax)
PERSONAL INFORMATION
Name of Applicant,
Including full middle name: ______
Address: City: State: Zip:
______
Cell Phone: ______Home Phone: ______
Email Address: ______
Place of Employment: ______
Job Title: ______
Date of Birth: ______Retired? Yes____ No____
Emergency Contact Person: ______Phone: ______
Relationship: ______
Do you have any physical disabilities or health concerns which would prevent you from performing certain kinds of work or in a certain work environment? Yes____ No____
If yes, please explain: ______
EDUCATIONAL INFORMATION
Are you a student? Yes____ No____
School:Major:Year in School:
______
What degree are you currently seeking? ______
Check all that apply:
High School/GED____Associate____Bachelor____Master____Other______
Degrees or certificates completed:
______
Specialty training or skills you have learned that may be used while volunteering
I.e. computer skills, speaking a second language, tutoring, crafts, technical skills, etc.
ARE YOU APPLYING FOR AN INTERNSHIIP with us?
Yes____ No____
If yes, what semester are you applying for? ______
How many total hours are required for your program? ______
Direct Hours Required: ______
Indirect Hours: ______
I.e. ODU’s Human Services program requires 400 total hours. This includes 100 direct & 300 indirect hours.
EXPERIENCE
Have you previously worked or volunteered with the YWCA? Yes____ No____
If so, when and what was your position? ______
Describe any current or previous volunteer experiences. ______
______
______
AVAILABILITY
Please place a check mark to correspond with your general availability.
Mon. / Tues. / Wed. / Thurs. / Fri. / Sat. / Sun.Morning
Afternoon
Evening
Overnight
INDICATE BELOW THE PROGRAMS THAT ARE OF MOST INTEREST TO YOU.
The following YWCA Direct-Service Programs accept both volunteers and interns. Participants within these programs mustcomplete a 32-Hour mandatory Introductory & Advanced Volunteer Training offered at the beginning of each semester, generally in January, May, August & sometimes November. Please also see page 5 of application for short answer portion of application required only for those pursuing direct-service with survivors.
Women in Crisis Shelter Volunteers and Interns are also required to pass a background check, paid for by the YWCA. We are required by law to conduct criminal background & sex offender registry checks for persons serving within our shelter as you will have exposure to children. Any person who has felony charges are advised to inquire about conflict of interests prior to applying. We appreciate your understanding, as our programs enable you to work directly with YWCA clients who are survivors of sexual assault and/or domestic/intimate partner violence.
Please list from 1-5 (1 being most interested and 5 being least Interested) your preference for service to the following program areas. In serving within any direct-service program you can only provide service within one program area at a time during your initial three months of service. This is because week one of Advanced Volunteer Training is introductory and intended for the whole group. In week two of training, the group splits into either a domestic violence-focused subgroup for those interested in serving within the shelter or Legal Advocacy Program, or a sexual violence-focused subgroup for those interested in serving on the 24-Hour YWCA Crisis Line & Sexual Assault Hotline. After your first three months of service, if interested, you may return to training to join the alternative subgroup in week two to prepare for service within the another program.
______Women in Crisis Domestic Violence Shelters & Programs
______24-Hour YWCA Crisis Line, with training provided by Response Sexual Assault Support Services of the YWCA
______YWCA Counseling Center* *requires a 2-semester commitment & is only available to MA Counseling students
______Legal Advocacy Program
______Community Outreach & Education Program
The following Indirect -Service Programs acceptvolunteers onlyand require that participants complete a 4-Hour mandatory Introductory Volunteer Training. Please also list from 1-5 (1 being most interested and 5 being least Interested) your preference for service to the following program indirect-service areas.
______YWCA Youth Services
I.e. school-year programs such as YWCA Kids BeforeAfter School Child Care
______Young Women’s Programs
I.e. summer-run programs for girls’ empowerment; these programs do acceptpracticum students (up to approx. 50 hours) during the summer semester
______Racial Justice Initiative
I.e. racial justice events planning, scholarships projects, etc.
______Administrative Office
I.e. front desk coverage, mailings, etc
______Development and Events Offices
I.e. fundraising and events planning, etc.
EXPERIENCE/SKILLS:
_____Children’s Programs
_____Teenagers’ Programs
_____Young Adult or College Programs
_____Baby Boomer Programs
_____Senior Citizen Programs
_____Staff Supervision
_____Volunteer Relationships
_____Group Leadership/ TeamBuilding
_____Community Organizing
_____Business Management
_____Social Media
_____Journalism/ Communications
_____Computer Skills (Microsoft Office)
_____Computers/IT
_____HTML/ Web Design
_____Public Speaking
_____Community Outreach/ Education
______Public Health Awareness
______Fundraising
______Grant Writing
______Events Planning and Assisting
______Advocacy
______Civil Rights
______Hotline
______Homelessness
______Mental Health
______Substance Abuse
______Self-Sufficiency Skills
______Financial Empowerment
______Stress Management/ Holistic Healing
______Arts & Crafts
______Maintenance
______Counseling/ Mentoring
______Other______
All Applicants must Sign (an electronic signature will suffice):
I understand that all volunteers, interns, and staff of YWCA South Hampton Roads must adhere to a strict confidentiality policy. I will not divulge information about anyone accessing our services.
I hereby certify that the facts set forth in the above application are true and complete to the best of my knowledge. I understand that completing this application does not ensure a volunteer or internship placement. I also understand that this is not an application for paid employment.
Applicant’s Signature: ______Date: ______
Thank you for your interest in joining the YWCA South Hampton Roads in our mission of eliminating racism and empowering women!
This following section is required only for applicants who are interested in pursuing direct services with survivors of sexual violence and/or intimate partner violence.
Please use additional paper, if necessary. Thank you for your time and consideration in responding.
Without compromising your privacy, briefly explain your interest in volunteering for YWCA. ______
______
______
______
Briefly describe domestic violence as you understand it. ______
______
______
______
Briefly describe sexual violence as you understand it. ______
______
______
______
______
Have you had any experience or training surrounding the issues of domestic violence, sexual violence, and/or the effects of trauma on children? ______
______
______
______
What do you perceive will be the most difficult aspect of this type of volunteer experience? ______
______
______
______