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24/7 Hotline: 419-289-8085

Office: 419-282-6097

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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.

There are some errors in your form.

Name: *

Date of Birth: *

Street: *

City: *

State: *

Zip: *

Cell Phone: *

Home Phone:

Email: *

How did you hear about Rape Crisis Domestic Violence Safe Haven? *

Skills and Experience. Check all that apply. *

Fundraising

Event Planning

Court Advocacy

Childcare

Hospital Advocacy

Computer Tech/Programming

Photography

Community Education/Outreach

Public Speaking

Support Group Facilitation

Telephone Counseling

Grant Writing

Other (please specify)

Have you ever participated in Safe Haven's services? If so, how long ago? *

Have you had any experience with domestic violence, sexual violence, and/or stalking (e.g. training, coursework, counseling, personal experience)? *

Do you had experience working with people in a crisis situation and/or direct or indirect work with survivors of domestic violence, sexual violence, and/or stalking? If so, explain: *

Reference Information 1: *

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

Reference Information 2: *

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

Reference Information 3: *

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

What level of training would you be interested in? *

Level 1 (1 hour training)

Level 2 (10 hour training)

Level 3 (40 Hour training)

If you chose Level 3, please check any interests that apply to you:

Face-to-face (peer support)

Crisis Line

Hospital Advocacy

Court Advocacy

Support Group

Childcare during support group

Public Speaking

Community Education

Other (please specify)

The following demographic questions are for grant and reporting purposes ONLY and are not used to evaluate your volunteer application. Responses will be reported in aggregate form only and will not tie back to your individual application. You may choose not to answer any of the following self-identified demographic questions.

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)

Have you ever been charged with a criminal offense (other than a traffic violation), neglect, abuse, or assault? If yes, date charged, date convicted, and where? *

Safe Haven completes routine background checks on all staff, interns, and volunteers at minimum every 5 years. Do you consent to completing a routine background check? *

Yes

Preferred method of contact: *

Phone
Email

I have completed this application honestly and to the best of my ability. I understand that I will meet with RCDV Safe Haven staff to discuss my volunteering and if mutually agreeable, will be scheduled to complete training in order to begin to volunteer. I promise to keep all client information confidential as well as the location of the Shelter. *

Signature:
Date:

Rape Crisis Domestic Violence Safe Haven of Ashland

Phone: 419-282-6097
Crisis Hotline: 419-289-8085
Fax: 419-496-0128

Safe Haven is a program of

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