Volunteer Application

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Ready to start volunteering with the Montrose Center? Fill out the application below!

Volunteer Application

"*" indicates required fields

Step 1 of 6

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Hidden

Status

Active

Inactive

Rejected

About You

Legal Name*

First Last

Nickname / Name You Go By

Address*

Street Address City State ZIP Code

Email*

Primary Phone*

Primary Phone Type*

Cell

Home

Work

Other

Secondary Phone

Secondary Phone Type

Cell

Home

Work

Other

Date of Birth*

Why is this required?

The Montrose Center conducts criminal background checks on most volunteer applicants. Access to these records requires an accurate date of birth. If records cannot be accessed with this information, additional data may be required such as Social Security number.

Social Security #

Optional. We may ask you to furnish this information at a later date.

More About You

Emergency Contact Name*

First Last

Emergency Contact Phone*

If you speak languages other than English, please specify:

Fluency

Speak

Read

Write

Orientation: How do you identify?

Lesbian

Gay

Bisexual

Queer

Straight

Other

Gender: How do you identify?

Cisgender Woman

Cisgender Man

Transgender Woman

Transgender Man

Genderqueer/Nonbinary

Intersex

Which pronouns do you use for yourself?

He/him/his

She/her/hers

Ze/hir/hirs

They/them/theirs

Any of the above

Something else

Other

What is your race/ethnicity?

Black/African American

American Indian/Alaskan Native

Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, or Vietnamese)

Native Hawaiian/Pacific Islander (Samoan, Guamanian, or Chamorro)

Hispanic/Latino (Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, or other Hispanic/Latino)

White, Non-Hispanic

Other

[expand title=”Why do we ask about orientation/gender?”]Both fields are optional. The Montrose Center does not discriminate on the basis of gender, orientation, or for that matter, race, ethnicity, nationality, age, religion, or disability. All personal information is kept confidential. This information supports us in acknowledging all of our volunteers accurately and respectfully. It also helps us determine which communities require additional outreach with regard to volunteer opportunities.[/expand]

Employment

What is your employment status?*

Employed full-time

Employed part-time

Retired

Permanent disability

Short-term disability

Unemployed

What is the name of your employer?*

Does your employer participate with Dollars for Doers or any other volunteer grants?

Yes

I don’t know.

Professionally, what kind of work do/did you do?*

Have you, your partner/spouse or any member of your family received counseling, treatment, case management or housing assistance at the Montrose Center within the last 24 months?*

Yes

Volunteer Experience

How many years' volunteer experience do you have?*

1-3

3-5

5 or more

Briefly describe your most recent volunteer experience.

Skills & Education

Are you a student?*

Yes

Status?*

Full time (12 hours/week or more)

Part time (9 hours/week or less)

What is the name of the school and specific program you are enrolled in?

(e.g., University of Houston – Graduate College of Social Work)

What is the highest level of education you have achieved so far?*

Some high school

Diploma / GED

Professional Certification

Some college

Associate Degree

Bachelor Degree

Master Degree

Doctorate Degree

Please list any licenses, certifications or professional credentials that you maintain:

Describe any hobbies, special skills, talents or interests that you would like to share:

Availability

How many hours per week would you like to volunteer (average)?*

Please indicate your general hours of availability below. We understand that this may change.

Schedule of Availability:

MON	TUE	WED	THU	FRI	SAT	SUN
Start End	Start End	Start End	Start End	Start End	Start End	Start End

Areas of Interest

Please check all that you might be interested in. This will in no way limit your potential assignment, nor does it guarantee an assignment in those areas.

General Center Support

Cyber Center Attendant

Technology Committee

Equal Grounds Café Attendant

Equal Grounds Café Committee

Front Desk Specialist (must take Crisis Intervention training)

Clerical support

Data entry

Building maintenance and construction

Landscaping/ beautification

Disaster Relief Volunteer

Events & Fundraising

Staff information table at outreach events

Represent the Montrose Center at fundraising events

Write thank-you letters

Invite your friends/contacts to events

Conduct tele-ask campaigns

Lead building tours

Behavioral Health & Wellness

Integrative Wellness Coach

Wellness Class Instructor or Educator (ex: walking group, nutrition )

Support Group Facilitator

Case Management Clerical Assistant

Quarterly Advisory Panel Volunteer

Veterans Community Leader

Details:*

Senior Services

Montrose Diner Lunch Server

Montrose Diner Host

Daytime Activity Leader

Advocate (outreach and education about senior services)

Details:*

Youth Services

Hatch Youth Facilitator

Hatch Prom & special events support

Youth outreach (must be LGBT age 18-25)

Evening Activity Leader (Tue/Fri/Sun)

Details:*

Student Internship

Undergraduate Intern

Graduate Intern

Semester / Year*

Total Number of Hours to Complete*

MSW and LPC candidates may not use this application for field placement consideration. Please contact your institution for information about placement with the Center.

Have you ever been convicted of or charged with a felony resulting in a disposition other than acquittal or dismissal?*

Yes

Please explain:*

Have you ever had any licensing board or professional ethics body require you to surrender your license or found you guilty of professional misconduct, unprofessional conduct, incompetence or negligence?*

Yes

Please explain:*

Have you ever had your professional license, professional liability insurance or bond denied, revoked, not renewed or suspended?*

Yes

Please explain:*

Are there any charges or complaints pending against you by any licensing board or professional ethics body for professional misconduct, unprofessional conduct, incompetence or negligence?*

Yes

Please explain:*

Are you aware of any circumstances that may result in any claim or suit being made against you regarding your current or past professional conduct?*

Yes

Please explain:*

Has any professional liability claim or suit ever been made against you for your professional conduct?*

Yes

Please explain:*

How did you learn about the Montrose Center's volunteer program?

Friend

Flyer / poster / handout

Print advertisement

Radio

Facebook

the Montrose Center / Hatch Youth website

Courts / criminal justice system

Other

Do you hold any beliefs or life experiences that may limit your ability to work with LGBT persons, elders, youth, suicidal persons, or survivors of sexual assault or domestic violence?*

Yes

Maybe / I’m not sure

Please explain:*

STANDARD AGREEMENTS

Please carefully read and click next to each statement to signify your agreement.

Use of Information*

I understand that this information in this application will be used, in part, to determine my eligibility for a volunteer position with the Center.

Authenticity*

I have read and understand the above information. I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if accepted as a volunteer, falsified statements contained on this application may be considered grounds for dismissal. I authorize investigation of all statements contained herein and contact of the references listed above to give you any pertinent information they may have. I release all parties from all liability for any damage that may result from furnishing same to the Center.

By entering your name and today’s date below, you further indicate that you agree with the above statements, and authorize Montrose Counseling Center, Inc. to process this application.

Name*

First Last

Today's Date*

MM slash DD slash YYYY