Volunteer Application | Simpson Housing

Basic Information

Name*

First Last

Nickname

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Birth Date*

Gender

What are your gender pronouns?

Ethnicity

Simpson Housing Services celebrates and embraces the uniqueness and dignity of every person and we model inclusive organizational structure and practices. As a community institution, we support diverse communities and offer programming and services that further racial and ethnic justice. We are committed to sustaining a diverse group of volunteers and, as an option, you may share your ethnicity.

Emergency Contact Information

Name*

First Last

Relationship to You*

Emergency Contact Phone Number*

Volunteer Position Interest

Volunteer Position Interest*

Why are you hoping to mentor a young person with Simpson Housing Services?*

Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

What are your hobbies and interests?*

What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

Can you commit to the Simpson Literacy Mentor Program for 10 months, being in contact with your mentee for weekly literacy lessons and monthly enrichment outings?*

Yes
No

Do you forsee any issues meeting the above requirement (ex: possible relocation, unreliable transportation, major life changes, etc.)

Please describe any personal vacation plans that may interfere with your ability to be a consistent volunteer for a student.

Do you have any medical or health-related concerns which could affect your ability to perform those activities expected of you as a mentor or ensure the safety of the student in your care, especially in the event of an emergency? If so, please explain.

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from their last service date with Simpson Housing Services.

Have you ever been refused participation in any other youth program? If yes, please explain.*

Do you have a current driver’s license and reliable vehicle?*

Yes
No

Have you had any driving citations and/or moving violations in the past 5 years? If yes, please explain.*

Have you ever been convicted of a crime? If yes, please explain.*

Have you ever been investigated or convicted of child abuse or neglect, or of sexually abusing a youth 18 years or younger? If yes, please explain.*

About You

Why do you wish to volunteer with Simpson Housing Services?*

Briefly describe previous volunteer experiences (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

Share your educational background, training, language skills, etc.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

What are your hobbies and interests?*

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from the exit date.

Position Interest*

Please indicate the volunteer position(s) you are interested in:

Shelter Evening Meal
Shelter Breakfast Meal
Youth Group Overnight Stay and Breakfast Meal
Family Housing Evening Meal
Special Event Meal

About your Group

Who is your group comprised of? (Faith community, corporation, civic organization, school, family/friends, other?)*

What is the name of your group?*

Does anyone in your group have experience cooking for a large group?*

Yes
No

What would your group like to get out of this volunteer experience?*

By submitting your application, you agree to the following:

I certify that my answers are true and complete and I understand that if they are not, I am disqualifying myself for a volunteer position.
I also understand that I am applying for a volunteer position and that this is not an application for, or a contact of, employment.
I understand that this application does not guarantee a placement, and that either Simpson or myself can terminate the process of applying at any point without an explanation.
I authorize the above references to give Simpson Housing Services any pertinent information they may have and authorize investigation of all statements contained in this application.

Why are you hoping to mentor a young person with Simpson Housing Services?*

Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

What are your hobbies and interests?*

What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.*

What language(s) are you proficient in?*

Employer*

What is your occupation (current or previous)?*

Can you commit to the Simpson Middle School Mentor Program for 10 months, being in contact with your mentee for weekly, and seeing them a minimum of 3 weeks out of each month?

Yes
No

Do you forsee any issues meeting the above requirement (ex: possible relocation, unreliable transportation, major life changes, etc.)

Please describe any personal vacation plans that may interfere with your ability to be a consistent volunteer for a student.

Do you have any medical or health-related concerns which could affect your ability to perform those activities expected of you as a mentor or ensure the safety of the student in your care, especially in the event of an emergency? If so, please explain.

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from their last service date with Simpson Housing Services.

Have you ever been refused participation in any other youth program? If yes, please explain.

Do you have a current driver’s license and reliable vehicle?

Yes
No

Have you ever been convicted of a crime? If yes, please explain.*

Have you ever been investigated or convicted of child abuse or neglect, or of sexually abusing a youth 18 years or younger? If yes, please explain.*

Why are you hoping to tutor a young person with Simpson Housing Services?*

Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

What are your hobbies and interests?*

What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.*

Do you have a license in education?

Yes, I have a current license
Not now, but I had a license in the past.
No

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

Can you commit to the Simpson Tutoring Program for the school year, participating in weekly tutoring sessions?

Yes
No

Do you forsee any issues meeting the above requirement (ex: possible relocation, unreliable transportation, unpredictable work schedule, major life changes, etc.)

Please describe any personal vacation plans that may interfere with your ability to be a consistent volunteer for a student.

Occasionally we are unable to place tutors because we have limited space, or a tutor’s schedule doesn’t allow for a weekly commitment. In the event that we cannot place you for weekly tutoring, would you be interested in being a substitute tutor? Substitute tutors are contacted when regular tutors are on vacation.

Yes
No

Students participating in the tutoring program are invited to attend monthly enrichment outings. Outings are typically on Saturday mornings and we need a few volunteers to assist with each outing. Is this something you would be interested in helping with?

Yes
No

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from their last service date with Simpson Housing Services.

Have you ever been refused participation in any other youth program? If yes, please explain.

Have you ever been convicted of a crime? If yes, please explain.*

About You

Why do you wish to volunteer at Adult Shelter Connect?*

Briefly describe previous volunteer experiences (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

Share your educational background, training, language skills, etc.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

What are your hobbies and interests?*

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from the exit date.

Have you ever been convicted of a crime? Please disclose all convictions in the last 10 years, including the year and state of conviction. Some of our positions involve confidential information and contact with vulnerable populations. Having a conviction doesn’t necessarily exclude you from volunteering.*

Are you currently attending school?*

Yes
No

Will you receive academic credit for your volunteer work?*

Yes
No

School Name*

Course Name*

Required Number of Hours*

Due Date*

Are you volunteering because of a court order?*

Yes
No

Jurisdiction Information*

Required Number of Hours*

Due Date*

About You

Why do you wish to volunteer in an emergency shelter?*

Briefly describe previous volunteer experiences (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

Share your educational background, training, language skills, etc.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

What are your hobbies and interests?*

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from the exit date.

Have you ever been convicted of a crime? Please disclose all convictions in the last 10 years, including the year and state of conviction. Some of our positions involve confidential information and contact with vulnerable populations. Having a conviction doesn’t necessarily exclude you from volunteering.*

Are you currently attending school?*

Yes
No

Will you receive academic credit for your volunteer work?*

Yes
No

School Name*

Course Name*

Required Number of Hours*

Due Date*

Are you volunteering because of a court order?*

Yes
No

Jurisdiction Information*

Required Number of Hours*

Due Date*

What would you like to get out of a volunteer experience?

Are you looking for a volunteer opportunity for yourself or for a group?

When are you typically available to volunteer?

Are you looking for something you can do from home, or are you looking for a direct service opportunity?

Would you prefer volunteering with children, adults, or both?

Are you currently attending school?*

Yes
No

Will you receive academic credit for your volunteer work?*

Yes
No

School Name*

Course Name*

Required Number of Hours*

Due Date*

Are you volunteering because of a court order?*

Yes
No

Jurisdiction Information*

Required Number of Hours*

Due Date*

Thank you for your interest!

Additional Information: References

Please list three persons, not related to you, who would have knowledge of your qualifications to volunteer. One of the references must be professional; such as a current or former employer, colleague, teacher, etc.

Name*

Full Name Phone Email Address Relationship

Name*

Full Name Phone Email Address Relationship

Name*

Full Name Phone Email Address Relationship

By submitting your application, you agree to the following:

I certify that my answers are true and complete and I understand that if they are not, I am disqualifying myself for a volunteer position.
I also understand that I am applying for a volunteer position and that this is not an application for, or a contact of, employment.
I understand that this application does not guarantee a placement, and that either Simpson or myself can terminate the process of applying at any point without an explanation.
I authorize the above references to give Simpson Housing Services any pertinent information they may have and authorize investigation of all statements contained in this application.

Initials

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