Volunteer Application

THANK YOU FOR YOUR INTEREST IN VOLUNTEERING WITH Prevent Child Abuse Vermont!

Please complete the form and a member of our staff will contact you soon.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone (Day)

(###)

###

####

Phone (Evening)

(###)

###

####

Place of Employment

Emergency Contact

Emergency Contact Phone

(###)

###

####

I am available (list times):

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

SUNDAY

I am interested in volunteering as a leader in a:

Nurturing Parenting Program Adult Group (4-5 hours a week for 9-23 weeks plus training)

Nurturing Parenting Program Children’s Group (4–5 hours/week for 9–23 weeks plus training)

Circle of Parents Adult Group (3–4 hours/week for 1 year plus training)

Circle of Parents Children’s Group (3–4 hours/week for 1 year plus training)

Have you lived in Vermont for at least the last 5 years? If not, please list your addresses during the past 5 years

How did you learn about PCAVT?

Why are you interested in becoming a PCAVT volunteer?

Please list any training or experience you have in child development, child abuse, etc.

Please explain your experience working with children. What ages?

Please explain your experience working with adults.

Please explain your experience working with groups.

How would you handle a conflict within a group?

What is your philosophy on discipline?

All PCAVT volunteers are mandated reporters of child abuse. What are your feelings about this?

How do you feel about working with families who may have experienced abuse in their home or working with people who have abused others?

How do you feel about working families whose member(s) have criminal histories?

Have you ever been convicted of a felony or a misdemeanor other than a minor traffic violation?

Yes

Please list three references. (name, relationship, and phone number)

I certify that all the information I have entered is correct and complete to the best of my knowledge.

I certify that all the information I have entered is correct and complete to the best of my knowledge. I understand that Prevent Child Abuse Vermont may verify information, and that untruthful or misleading answers are cause for rejection of this application, removal of my name from a register, or dismissal if accepted.

Background Check

PCAV requires background checks of volunteers.

If accepted as a volunteer, I will submit to a background check. We welcome any help from volunteers in covering the cost of the background check.