Personal Information First Name* Middle Initial Last Name* Gender ---MaleFemale Date of Birth Street Address City State Zip
Contact Information Primary Phone* Work Phone E-Mail Address*
Emergency Contact Information Emergency Contact Contact Phone Number Contact Relationship If you are applying for a volunteer assignment behind base security, do you currently hold a government-issued base access pass? Yes No Some volunteer positions require a background check. Would you be willing to submit to a background check if required? Yes No Current Employer Are you active Military?---YesNo
Military Affiliation None Active Military Guard/Reserve Retired Military Veteran Dependent Family Member Friend
Why do you Want to Volunteer with PTSD USA? (please check all that apply) I believe in the Mission I am active duty military and want to support my colleagues, build skills, or give back to the community I am a military spouse and want to support the troops I am retired military and want to give back I am the spouse of retired military and want to give back I am the parent of an active duty service member and want to lend my support I have a family member or friend in the military and want to lend my support To fulfill a court-required community service orderOther (please describe)
Interests What Kind of Assignments are you Interested in Doing with PTSD USA? Providing service to troops & families Working one-on-one Fundraising General office administration Special Events Public Speaking Research Specialized professional services Assembling packets and mailings Anything and everything
Skills What are your Special Skills and Abilities? (please check all that apply) Administrative/Clerical Skills: Copier, fax, and file Data entry Microsoft Excel Microsoft Word Pleasant phone skills Problem solving Proof-reading skills Strong English language skills Verbal communication Written communication Other skills or languagesCustomer Service Skills: Enjoy people Excellent verbal communication Good listening skills Maintain cleanliness of center Problem solving Team-orientated Visitor focusedSpecialized Skills: CPA and/or accountant Fundraising Information Technology Legal Medicinal PR/Marketing/CommunicationsCertification/Licensure: Drivers license Other vehicle license Forklift operator Food handling license Other certification/licensure
When are you Available to Serve? Monday A.M. Monday P.M. Tuesday A.M. Tuesday P.M. Wednesday A.M. Wednesday P.M. Thursday A.M. Thursday P.M. Friday A.M. Friday P.M. Any Weekday A.M. Any Weekday P.M. Saturday A.M. Saturday P.M. Sunday A.M. Sunday P.M. Any Weekend A.M. Any Weekend P.M. How Often Can You Serve Daily Weekly Once Per Month A Few Times A Year One Time OnlyOther(please specify)
Length of Commitment Ongoing Six to Twelve Months Three to Six Months Less than Three Months
How did you Hear About this Opportunity? Select all that apply: Radio/TV Print Advertisement A PTSD Volunteer Another Agency A Friend SchoolOther
