volunteers make a difference!Thank you for your interest in volunteering for MHA. Just complete the volunteer application below and hit submit. Your Name (required) Your Email (required) Your Phone (required) Current Street Address (required) Current City (required) Current State (required) ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Current Zipcode(required) Is your current address the same as your permanent address? YesNo Date of Birth Sex MaleFemaleNon-Binary Work and Volunteer Experiences Please list your most recent work and volunteer experiences Experience 1 Start Date Experience 2 Start Date Experience 3 Start Date Education Are you presentely a student? YesNo What school do you attend? Does volunteering fulfill a course requirement? YesNo Please Describe the Course Requirement Please list your most current and/or previous educational experiences, listing your most recent experience first Criminal History Have you ever been arrested? YesNo Have you ever been convicted of a crime? YesNo Do you give us permission to check this information? YesNo Personal Information Program Interests (required) AdministrationCrisis Center"I'm Thumbody Special"Health FairsSupport GroupsOther Why are you interested in volunteering for MHA? (required) What experiences, hobbies, skills do you have which might help MHA? (required) Please list your community interest or groups with whom you are affiliated References Please list three local references who we may contact. Reference #1 Name (required) Phone Email Relationship How long have you known this person? Reference #2 Name (required) Phone Email Relationship How long have you known this person? Reference #3 Name Phone Email Relationship How long have you known this person? I authorize Mental Health America to contact my references that I have provided above, and to inquire about my volunteer candidacy. The above-named persons are aware that Mental Health America will contact them and MHA has my permission to discuss any relevant information. Emergency Contact Name Phone Alternate Phone Address Relationship Verification By signing my full name, I hereby certify that the information on this application is accurate and complete to the best of my knowledge. Signature
