Volunteer Application PDF (1) .pdf

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Original filename: Volunteer Application PDF (1).pdf
Author: Vista

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Page |1

Volunteer Application
Personal Information
Name: ____________________________________________ Date of Birth: _____ /_____ /__________
Street Address: __________________________________________________________________________________
City: ____________________________ State: _________________ Zip Code: _____________________
Phone Number: ___________________________________ Email: ________________________________________
Preferred Method of Contact (circle one): Call / Text / Email Gender Pronouns: _________________
What language(s) do you speak? ________________________________________________________________
Do you have access to a car? □ Yes □ No
How did you hear about the MATCH Program? ___________________________________________________

Availability
Are you able to volunteer 4 hours per month for at least 1 year?

□ Yes

□ No

To help us match you with someone whose schedule is compatible with yours, please check the
boxes that correspond with your availability during a standard week in the table below:
Monday

Tuesday

Wednesday Thursday

Friday

Saturday

Sunday

Morning
Afternoon
Evening
What does the word ‘dependable’ mean to you? Why does dependability matter?

Updated: September 2016

Page |2

Application Questions
1. Please describe a significant work, academic, or volunteer experience you’ve had. What skills or
lessons from this experience will you be able to apply towards being a MATCH Program Ally?

2. Have you volunteered before? If so, what did you like about that experience? What could have
made that experience better for you?

3. Why do you want to be a MATCH Program Ally?

3A. What benefits do you think may come from being a MATCH Program Ally?

3B. What challenges do you think may come from being a MATCH Program Ally?

4. Describe your communication style. What are your strengths and weaknesses?

Updated: September 2016

Page |3

Interest Survey
Please answer these questions as completely as possible! The better we know you, the better we
can match you. Feel free to add any other information about yourself, likes and dislikes, etc. that
you would like to share that we did not ask about 
Check all activities below that interest you:
□ Hiking

□ Going to local events

□ Cooking/ Baking

List one of your favorite…

□ Gardening

□ Spending time at the park

□ Board games

Books:

□ Shopping

□ Crafts i.e.-__________________



Movies:

□ Reading

□ Biking (mtn., road, or both?)



Musicians:

□ Climbing

□ Visiting art galleries



Foods:

Describe your ideal “day off”

How do you like to spend time with your family and friends?

How do you deal with stress? What do you do to take care of yourself?

What five words describe you the best? ____________________________ ____________________________
_______________________________ _______________________________ _______________________________
What is a new skill that you would like to learn? __________________________________________________
What is a skill that you would like to teach others? ________________________________________________
Anything else you’d like to tell us?

Updated: September 2016

Page |4

Personal Reference
Please provide the name and contact information of two individuals that you have known for at
least one year and would like to serve as your character reference.
Name: _______________________________________________ Best time to contact: _______________________
Phone number: _____________________________________ Email: _______________________________________
Relationship to you (and for how long?) __________________________________________________________
Name: _______________________________________________ Best time to contact: _______________________
Phone number: _____________________________________ Email: _______________________________________
Relationship to you (and for how long?) __________________________________________________________

Criminal History
Will you be able to pass a criminal history background check?

□ Yes

□ No

If no, please explain: ______________________________________________________________________________
___________________________________________________________________________________________________

Next Steps
Thank you for your interest in becoming a MATCH Program Ally! Here are a few more steps you
need to complete to be considered for this volunteer opportunity.
1. Submit this completed application to Seekhaven by:
- Dropping it off at our office (81 N 300 E Moab, UT 84532)
- Emailing it to vista@seekhaven.org
- Mailing it to PO Box 729 Moab, UT 84532 or faxing it to (435) 259-7856
2. Call Seekhaven at (435) 259-2229 to set up a time to meet with the Volunteer Coordinator.
This will just be a casual meeting for us to be able to get to know you better, talk more about the
MATCH Program, and answer any questions you may have!
3. Attend the next Volunteer Orientation: _________________________________________________________

By signing below, I attest to the truthfulness of all the information listed on this application.
Signature: __________________________________________________________ Date: ________________________
Print Name: _________________________________________________________

Updated: September 2016


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