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Volunteer Request Form 2019-2020
About the Organization
Name of the Organization/School
Dominican Congregation/Province Affiliation (if applicable)
Executive Director/Administrator Name
Organization Contact Person and Title (if different)
Phone Number
E-mail
Organization Street Address
City, State, Zip Code
Organization Website
Setting
Urban
Rural
Suburban
Other
Number of Part-Time/Full-Time Staff
Do you have general liability insurance that would cover the volunteer for both on and off site activities?
Yes
No
Let's talk about this
Are you able to provide health insurance for the volunteer?
Yes
No
Let's talk about this
Organization's Mission Statement
Organization's History
Demographics Served (ethnicity, age, economic background, etc.)
Social Justice Impact
Please describe how your organization directly or indirectly works for social justice (e.g., What community needs have been identified? How are they met? Is your method unique in some way? What criteria is used to determine who receives services from your organization?).
About the Position/s
How many volunteers are you requesting?
one
two
What is the job title for position #1?
What is the job title for position #2 (if applicable)?
Name of Immediate Supervisor for position #1?
Name of Immediate Supervisor for position #2 (if applicable)?
Immediate Supervisor Phone Number (position #1)
Immediate Supervisor Phone Number (position #2)
Immediate Supervisor E-mail (position #1)
Immediate Supervisor E-mail (position #2)
Orientation, Training, Supervision
Describe the orientation, training, and ongoing supervision that will be provided for the volunteer.
Indicate training your organization provides its staff.
Professionalism
Sexual Harassment
Anti-Racism
Self-Care
Anti-Sexism
Tolerance
Effective Listeening/NVC/Compassionate Communication
Other relevant training related to the mission of DVUSA.
Is public transportation accessible?
Yes
No
Must the volunteer have a valid driver's license?
Yes
No
Is a personal car necessary?
Yes
No
Let's talk about this
Most of our incoming volunteers do not have cars. If placement depends on an available vehicle, would your placement be willing to consider providing one?
Yes
No
Let's talk about this
What is the dress code for the position/s requested?
Facility
Briefly describe the facilities where the volunteer will work (e.g., office space, technology available, stairs/elevators, bathroom availability, etc).
Are you applying to other volunteer programs for the same position?
Yes
No
Relationships with other volunteer organizations
If you are applying to other volunteer organizations for the same position, please state which organization and your status with them.
Funding for the volunteer position
If funding is not yet secured, please indicate when it will be secured or any other financial information that may be relevant to our planning.
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