Youth Resources of Southwestern Indiana Adult Volunteer Application

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PERSONAL INFORMATION

Name *

First

Last

Cell Phone *

Personal Email *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Pronouns *

She/her
He/him
They/them
Other

Check all that apply.

Which pronouns do you prefer?

Birth Date *

T-Shirt Size (Adult sizes only) *

EMPLOYMENT INFORMATION

Employer *

Job Title *

Work Email *

Work Phone *

Work Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Which method(s) of communication do you prefer YR to use? (Check all that apply)

Work email
Personal email
Work phone
Cell phone

YOUTH PROTECTION

Have you at any time ever been arrested for any reason? *

Have you at any time ever been convicted of or pleaded no contest to a crime? *

Have you at any time ever been engaged in child molestation, exploitation, or abuse? *

Have you at any time ever been accused of child molestation, exploitation, or abuse? *

Have you at any time ever been addicted to drugs or alcohol? *

Are you aware of having any traits or tendencies that could pose any threat to youth or others? *

Are you aware of any reason why you should not work with youth or others? *

Are there any facts or circumstances involving you or your background that would call into question your ability to be trusted with the supervision, guidance and care of youth? For example: Mental/physical health issues, contraction of a communicable disease, or an experience with abuse or molestation *

INTEREST

How did you learn about Youth Resources? *

Who are 1-2 people who have influenced you most in your desire to volunteer with Youth Resources? (If applicable)

First/Last Name and Relationship

Why do you wish to volunteer with Youth Resources? *

Have you attended any Youth Resources’ programs/events? If yes, what programs/events and when?

Volunteer Interests (Check all that interest you) *

Special events
Alumni engagement
Parent engagement
Programs
Other

Special Events (Check all that interest you)

Scooter Scramble
Scooter Scramble Auction
Fall Festival
YR Day
Trivia Night
YR Homecoming
Big Man On Campus
Hall of Fame
Alumni Weekend
Anniversary Events

Programs (Check all that interest you)

Make A Difference Grants
Teen Advisory Council (TAC)
TEENPOWER
Vanderburgh County Teen Court

If other, please describe:

EXPERIENCE

What kind of experience do you have working with adolescents? *

What knowledge in the fields of alcohol and other drug abuse education, intervention, prevention, and treatment do you have? *

Do you have any other qualifications that we should know about?

Life Saving/Water Safety
Crisis Counseling
First Aid
Registered Nurse
CPR
QPR
Licensed Clinical Social Worker
Other

If other, please describe:

What skills do you bring to Youth Resources that you think will help move the agency and/or our students forward? *

REFERENCES

Reference #1

Please list two character references (no relatives or Youth Resources staff).

Reference #1 Name *

First

Last

Work Phone *

Cell Phone *

Email *

Which method(s) of communication do they prefer YR to use? (Check all that apply) *

Work phone
Cell phone
Email

Reference #2

Reference #2 Name *

First

Last

Work Phone *

Cell Phone *

Email *

Which method(s) of communication do they prefer YR to use? (Check all that apply) *

Work phone
Cell phone
Email

BIOGRAPHY

Please write a short paragraph biography (in third person) that details your education, professional experience, community involvement, and any personal details you would like to share (spouse/partner & children's names, YR alumni status, hobbies, etc.) *

Health, Liability & Photo Release

Please open in a new tab and submit your completed Health, Liability & Photo Release forms at this link.

Youth Protection & Mandated Reporting Policies

Please open in a new tab and submit your completed Youth Protection & Mandated Reporting Policies at this link.

Signature

Waiver

The information contained in this application is correct to the best of my knowledge. I authorize any references or organizations listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for working with Youth Resources of Southwestern Indiana, Inc. (Youth Resources). In consideration of the receipt and evaluation of this application by Youth Resources, I hereby release Youth Resources and any individual, church, reference, or any other person or organization, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, executors, administrators, or assigns resulting from compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Should my application be accepted, I agree to be bound by the bylaws and policies of Youth Resources of Southwestern Indiana, Inc. and to refrain from inappropriate conduct in the performance of my services on behalf of Youth Resources. I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF, AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understood.

Signature *

Type your first and last name above as your electronic signature.

Date *