Volunteer Interest Form Name*Date of Birth*Address*City*State*Zip*Best Contact Number*Email*What is the best way to contact you?*Which clinic location do you prefer to volunteer at?Central San JoseEast San JoseMountain ViewUnion CityHow did you hear about us?*What Church/Organization do you attend?Volunteer Experience 1st Program/AgencyPositionSupervisorPhone2nd Program/AgencyPositionSupervisorPhoneEducation/Skills Highest level of educationHigh School/GEDSome CollegeAssociatesBachelorsMastersPhDLicenses/certificationsAre you currently a student?YesNoName of SchoolDescribe other training, skills, talentsIf you speak languages other than English, please list them including ASL and specify if you can speak, read, write and/or sign them.ProfessionEmployerMany companies award employee volunteerism by providing donations to the agencies their employees volunteer with. Does yours?YesNoI'm Not SureAvailability Monday Morning Afternoon EveningMonday: OtherTuesday Morning Afternoon EveningTuesday: OtherWednesday Morning Afternoon EveningWednesday: OtherThursday Morning Afternoon EveningThursday: OtherFriday Morning Afternoon EveningFriday: OtherSaturday Morning Afternoon EveningSaturday: OtherSunday Morning Afternoon EveningSunday: OtherSkills Clerical/Office Administration Communications/Writing Counseling Event Planning Graphic Design Medical Professional Microsoft Office Suite Project Management Public Speaking Social Media PhotographyAreas of Interest Administration/Helping HandsDescription: Help with administrative projects, data entry, phone calls, stuffing envelopes, preparing mailers. Time Commitment: Project based, flexible hours AmbassadorDescription: As an Ambassador you will take a leadership role in your church by working with your senior pastor, leaders, members of your church and RealOptions. Help connect your church to RealOptions so that they know about all of our service offerings and volunteer opportunities. Time Commitment: Varies, 1-4 hours per month. Some training and team meetings required. Community EngagementDescription: Be a team captain for the Walk for Life, coordinate a tour at a RealOptions Clinic, invite RealOptions to do a presentation to your life group, coordinate a donation drive, coordinate a RealTalk presentation with your youth group, be an Ignite Life host. Creative ideas welcome! Time Commitment: Project based, flexible hours College Campus OutreachDescription: Assist with outreach and awareness through local college campus student groups. Time Commitment: Varies, table training required. Community OutreachDescription: Engage in varying outreach activities and tabling events representing RealOptions to the community such as health fairs, community fairs, festivals, churches, schools, and events. Time Commitment: 2-4 hour shifts. Training required. Days and times vary based on event specifications. EducatorDescription: Present RealTalk, a multimedia interactive presentation that engages students in dynamic discussions and models healthy lifestyle choices. Time Commitment: Varies. Training required. Days and times based on scheduled presentations in the classroom. Event Planning/SupportDescription: Help in a variety of roles: promoter, greeter, set up, tear down, parking, registration, food, attendee traffic, and first aid. Time Commitment: Varies. Days and times based on event specifications. Some training may be required. HOPE Facilitator/Admin & Rachel's Vineyard RetreatsDescription: Work with Hope team to provide healing opportunities for anyone impacted by pregnancy loss, miscarriage, or abortion. Help with administrative projects, support groups, or in the Rachel's Vineyard volunteer team. Time Commitment: Varies, some training may be required. Medical ProfessionalsDescription: Registered nurses, nurse practitioners, sonographers, midwives and medical OB/GYN doctors willing to donate their time and skills to provide pregnancy tests, STD testing and treatment, well woman care, prenatal care, abortion pill reversal treatment as well as medical educators on topics such as prenatal nutrition, fetal development, childbirth, parenting, and lactation. Time Commitment: RN: 4 hour shift per week on the same day to perform pregnancy tests, STD Testing, and patient education. One year commitment. Training is provided and required. RN and/or Sonographer: Provide Ultrasound services. 4 hour shift per week on the same day. Training is provided and required. One year commitment. Nurse Practitioner, RN, MidWife, OB/GYN Prenatal Clinic: 4 hour shift per month. One year commitment. Childbirth Instructors: Labor and Delivery Nurse Once a week for two weeks per quarter. Patient Services AdvocateDescription: Patient Advocate offers ongoing compassionate care, support, education, resources and referrals. Time Commitment: 4 - 8 hour commitment per week for 1 year following training. Male Patient Advocates - Description: Patient Advocate offer compassionate care, education, resources and referrals. Time Commitment: On Call As Needed, training required. Practical SupportDescription: Washing, sorting, folding, labeling and packaging donated items and keeping our support rooms organized. Time Commitment: Varies Prayer VineDescription: Pray for the requests and needs of the people that we serve. Time Commitment: Daily What is your #1 interest?*What is your #2 interest?Please enter 62:** indicates a required field.
