First Name: * Last Name: * Address: Apt#: City: Postal Code: Home Phone: Business/Cell Phone: Email Address: * Other languages spoken fluently: FrenchItalianPolishSpanishVietnamese Other (please indicate language): Volunteer Opportunities (please select all that interest you): Office Support Tutor Childcare Support Residential Life Skills Information Ambassador Research Volunteer Fundraising & Events Peer Mentor Youth Advisory Committee Supervised Visitation and Exchange Niagara (SVEN) How did you learn about volunteer opportunities with our agency? Newspaper Pathstone Staff/ Volunteer Information Niagara School Pathstone Website Other Why are you interested in volunteering with Pathstone Mental Health? What skills do you feel you can contribute as a Volunteer? (academic, experience, etc.) Outline your previous volunteer experience: Some volunteer positions require building relationships with clients, which can be a slow process. Are you able to commit to volunteering for: 6 to 12 months 12+ months What is your availability? Mornings Afternoons Evenings Weekdays Weekends Flexible Do you have access to a vehicle? Yes No Do you have at least $2 million liability insurance for your vehicle? Yes No What do you enjoy in your leisure time? (Hiking, recreational activities, biking, art, musical instruments, gardening etc) References: Provide 2 references which are current, professional, and have known you for 2 years or more. Provide 1 reference which is a Family member. Reference 1 Name Address Phone Email Relationship Reference 2 Name Address Phone Email Relationship Reference 3 Name Address Phone Email Relationship
