Volunteer Application

This is a confidential application for a volunteer position with Rape Crisis Domestic Violence Safe Haven. The information you provide will be used by the Volunteer Coordinator for the sole purpose of the volunteer screening process. All information provided will be kept confidential. Please answer all questions as completely as possible. 

Return your application to RCDV Safe Haven 2233 Rocky Lane, Ashland, OH 44805, or hit the submit button at the end of the survey. To email an application or ask questions, please contact Rebecca Garcia at 419-281-3716 or  rgarcia@safehavenofashland.org














Name:
Address:
City, State, Zip:
Telephone (H):
Telephone (W):
Relationship:
Name:
Address:
City, State, Zip:
Telephone (H):
Telephone (W):
Relationship:
Name:
Address:
City, State, Zip:
Telephone (H):
Telephone (W):
Relationship:












Race (describe)
Gender Identity (describe)
Disability (yes or no)
Veteran (yes or no)
Limited English Proficient (yes or no)
LGBTQI (yes or no)
History of Gender-Based Victimization (yes or no)




Signature:
Date: