Is your current address the same as your permanent address?

    Date of Birth


    Work and Volunteer Experiences
    Please list your most recent work and volunteer experiences

    Start Date

    Start Date

    Start Date


    Are you presentely a student?

    Does volunteering fulfill a course requirement?

    Please Describe the Course Requirement

    Criminal History

    Have you ever been arrested?

    Have you ever been convicted of a crime?

    Do you give us permission to check this information?

    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


    Please list three local references who we may contact.

    Reference #1

    Reference #2

    Reference #3

    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


    By signing my full name, I hereby certify that the information on this application is accurate and complete to the best of my knowledge.

    volunteers make a difference!


    As our community continues to grow and change, MHA Crisis Center is growing and changing to meet the needs of our community.  The mission and the basic services remain constant:  to provide free and confidential crisis intervention, suicide prevention, and referral information through trained volunteers to those in need – any problem, any time.


    For any questions, please email Jessica Joya, Volunteer Coordinator at