Intern or Direct Service Volunteer Application

Please provide us with your information and you will be contact about volunteer opportunities.

1Application > 2Waiver > 3Confidentiality > 4Policies and Procedures
Name Name * First Last
Email
Phone Phone * - ### - ### ####
Today's Date Today's Date * / MM / DD YYYY
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County of Residence *
(City and State) *
Date of Birth Date of Birth * / MM / DD YYYY
Social Security number *
Driver's License Number
License Expiration License Expiration / MM / DD YYYY
Drivers License State
Hair Color *
Eye Color *
Weight *
Height *

Enter Days You Are Available to Volunteer
	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Morning	MorningMonday	MorningTuesday	MorningWednesday	MorningThursday	MorningFriday	MorningSaturday
Afternoon	AfternoonMonday	AfternoonTuesday	AfternoonWednesday	AfternoonThursday	AfternoonFriday	AfternoonSaturday
Evening	EveningMonday	EveningTuesday	EveningWednesday	EveningThursday	EveningFriday	EveningSaturday

What Kind of Commitment Are You Able to Make To NOA: *

What Kind of Commitment Are You Able to Make To NOA: Weekly Every Other Week Monthly One Time Project or Event Other Other
We appreciate your interest in volunteering with NOA. The following questions will help us learn more about you and match your interests to NOA's program needs. Some of the i nformation requested reflects our need to protect the safety, privacy, and health of our clients; while other i nformation i s necessary to meet the Georgia Department of Human Resources (DHS) Standards for Famil y Violence Shelter Program. Please feel free to call us at (706) 344-3853 if you have any questions about the application or the volunteer program.
**Due to the safety of our staff and clients. only traffic violators (including DUl's} are able to volunteer with NOA.

_-Have you ever been convicted of any crime other than a traffic violation?
*
Emergency Contact Name: Emergency Contact Name: * First Last
Emergency Contact Phone # Emergency Contact Phone # * - ### - ### ####
Education (High School/College/Special Training) (Names of school, dates attended/degrees obtained/location *
Previous Volunteer Experience (Organization, Position, and Supervisor) *
Current Job (Company, Position, Supervisor, Phone, City & State) *
How Did You Hear About NOA *
Have You Or Someone You Know Experienced Domestic Violence? *
Why Do You want to Volunteer At NOA *
What Are Your Hobbies, Interests & Skills?
*
Reference #1 (non family) Reference #1 (non family) * First Last
Reference #1 Address Reference #1 Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Reference #1 Phone Reference #1 Phone - ### - ### ####
Reference #2 non family Reference #2 non family * First Last
Reference #2 Address Reference #2 Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Reference #2 Phone Reference #2 Phone * - ### - ### ####
Reference #3 Reference #3 * First Last
Reference #3 address Reference #3 address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Reference #3 phone Reference #3 phone * - ### - ### ####
Volunteer Signature *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date of Volunteer Signature Date of Volunteer Signature * / MM / DD YYYY