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Volunteer Application

Please download the application here (PDF viewer required)

You can also fill out this form online. Please note: almost all the fields are required. It should take about 20 minutes.

Volunteer Application

First Name(*)

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Last Name(*)

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Email(*)

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Home Address(*)

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Apt

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City(*)

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State(*)

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Zip(*)

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Home Phone(*)

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(include area code)

Cell Phone(*)

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(include area code)

Place of Employment

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Gender(*)

FemaleMale Invalid Input

Date of Birth(*)

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Maiden or other names/alias

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Emergency Phone(*)

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Emergency Contact(*)

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Do you speak a 2nd language

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Do you drive?(*)

YesNo Invalid Input

Do you have regular access to a car?(*)

YesNo Invalid Input

You will be asked for your driver's license and insurance if we proceed with your application.

Please list your skills and interests(*)

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Please list three references of people who know you well, other than relatives, preferably for whom you have worked in either a paid or volunteer capacity:

Name(*)

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Phone(*)

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Email(*)

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Mailing Address(*)

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Name(*)

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Phone(*)

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Mailing Address(*)

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Name(*)

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Phone(*)

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Mailing Address(*)

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Can you think of any reason why a judge might be reluctant for you to serve as a Child Advocate Volunteer?(*)

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Dearborn-Ohio County Child Advocate Program reserves the right to make any checks deemed appropriate as to the suitability of anyone responsible for this confidential work. All information obtained will be held in the strictest confidence.

By submitting this form I agree that all information is correct and I am willfully submitting this application. By clicking 'yes' I affirm my submission.(*)

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(*)

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