VOLUNTEER APPLICATION                                   Date _____/________/________
                                                                                               DD      MM          YEAR

I.          PERSONAL INFORMATION

First Name:                                                                   ____    Last Name:                                                        ______ 

Address: __________________________________________________________________________________________

City, State & Zip:  __________________________________________________________________________________

County / Parish:_________________________________________________________________________            ______

Home Phone (      )                                                       _____  Work Phone (      )                                            ______

E-mail Address: _____________________________________    Birth Date:  _____/_____/   ¨ I am 18 yrs or older

                                                                                                                     DD  /        MM /

If you are under 18 years of age, you must have a parent / legal guardian sign page 5 of this application form.

Emergency Contact:                                                      ____________Emergency Phone (      )                                    ______

Relationship to you: _________________________________________________________________________________

Are you a victim/survivor of a drunk driving crash?                     ¨  Yes             ¨  No

If yes, date of crash: __________________________________ Date of criminal disposition: _______________________

Please indicate if you have been convicted or have pending charges in the following areas:

Do you have a valid driver’s license?                  ¨  Yes             ¨  No             

Do you have valid auto insurance?                      ¨  Yes             ¨  No 

If required, can you provide proof of insurance?  ¨  Yes             ¨  No

Do you have your own transportation?                ¨  Yes             ¨  No

II.        EMPLOYMENT & EDUCATION

Employment:     ¨  Full Time                 ¨  Part Time                ¨  Retired                    ¨  Not Employed

Current Occupation: _________________________________________________________________________________

Work Experience: ___________________________________________________________________________________

__________________________________________________________________________________________________

Educational:      ¨  High School             ¨ College                     ¨  Graduate School                   ¨  Technical School               

¨  Other: ______________________________________  Degree/Diploma(s) Obtained:                                           ______

III.       STUDENTS

Are you currently a student?      ¨  Yes           ¨  No        ¨  Day School         ¨  Full-time         ¨  Part-time

If yes, where are you currently attending? ________________________________________________________________

Current course of study? _____________________________________________________________________________

IV.       LANGUAGE

Do you speak any languages other than English?

Language __________________________________________ Conversational Fluency: ¨  Fair   ¨  Good   ¨  Excellent

Language __________________________________________ Conversational Fluency: ¨  Fair   ¨  Good   ¨  Excellent

American Sign Language?                     ¨  Yes             ¨  No

V.        AREA OF INTEREST

Please indicate 1^st, 2^nd, and 3^rd choice from the list below. 

Please note: some volunteer positions/programs may not be available in all communities.

VI.       AVAILABILITY

MADD volunteers are asked to seriously consider a commitment of four hours per week for at least six months (Some programs require a one-year commitment. Check program requirements in Volunteer Opportunities Information Sheet).

                                    M         T          W         Th        F          Sa        Su

Morning                        ¨         ¨         ¨         ¨         ¨         ¨         ¨

Afternoon                     ¨         ¨         ¨         ¨         ¨         ¨         ¨

Evening                        ¨         ¨         ¨         ¨         ¨         ¨         ¨                                 Flexible Schedule  ¨

VII.     ADDITIONAL INFORMATION

How Did You Hear About Us?

¨  MADD Event                      ¨  MADD Website                  ¨  Brochure                 ¨  MADD Staff/Volunteer

¨  Newspaper                          ¨  Friend/Family                       ¨  TV                          ¨  School/University

¨  Community Event                 ¨  Recruitment Website (i.e. VolunteerMatch)               ¨  Volunteer Center

¨  Other:                                  ________________________________________________________________________

Why do you want to volunteer for MADD?

¨  Community Involvement                   ¨  Work Experience                 ¨  Support MADD’s mission                

¨  College or School Credit Community Service                         ¨  Other: ______________________________        

VIII.    PERSONAL EXPERIENCE

1.  What skills / experiences are you hoping to gain from your volunteer experience with MADD? ____________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________

2. What kind of skills /experiences/interests/personal characteristics will you bring to MADD as a volunteer? __________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

3. Are there any issues, situations or kinds of experiences that you find unacceptable or difficult to deal with? If so, please share the situations / experiences and explain how you would respond. __________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

4. How do you handle stress and emotional difficulties in your own life?

____________________________________________________________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________

5. While volunteering at MADD, you may work with people who have different values and life experiences than yourself. What personal qualities can you share to help you to work with people of various backgrounds and experiences?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6. Have you previously volunteered or applied to be a volunteer with MADD?      ¨  Yes             ¨  No       

If yes, when, where and in what role/program?____________________________________________________________

7. What organizations do you volunteer with or have you volunteered with in the past? Please state your role and the dates you volunteered.____________________________________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________

8. What did you enjoy the most about your previous volunteer experience? _____________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________

9. What did you enjoy the least about volunteering? ________________________________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________

10. Please describe your past experiences or activities that include working with youth. __________________________________________________________________________________________________

__________________________________________________________________________________________________

11. Is there anything in your history that would limit or prohibit you from working closely with youth?  If yes, please describe. __________________________________________________________________________________________

__________________________________________________________________________________________________

12. You may be required to have a background check performed. Is this a concern to you?          ¨  Yes              ¨  No