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Volunteer Application

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How Can I Volunteer?
Volunteer Application

Personal Information

First Name:

Last Name:

Date of Birth:

Email Address:

Languages (other than English):

Phone (Home):

Phone (Work):

Phone (Cell):

Address

Address:

State:

City:

Zip:

Education

Please select the most recent completion:

High School - 9 High School - 10 High School - 11 High School - 12 College - 1st yearCollege - 2nd yearCollege - 3rd YearCollege - 4th YearGraduate - 1st YearGraduate - 2nd YearGraduate - 3rd YearGraduate - 4th Year

Field of Study / Degree:

Name of School / College:

Employment

Place of Employment:

Your position or title:

Can we call you there? YesNo

Employment Address:

Emergency Contact Information

Notify in Case of Emergency:

Relationship:

Emergency Contact Address:

Emergency Contact Phone:

Volunteer Experience

1. Agency:

Location:

How Long:

2. Agency:

Location:

How Long:

Do you have any special skills or services? Please List:

Please Indicate: I have not applied to Silverleaf beforeI am a past volunteer. I have applied before

What areas are you interested in:
Please select areas in which you are willing to volunteer. General Office Work (special mailings, phones, filing)Fundraising/Special Events. Hotline/Hospital Advocacy Education/Health Fair Volunteer

How did you hear about Silverleaf?:

SL Staff/Board Member SL Volunteer Friend Radio Website Newspaper Health Fair Other

Have you ever been arrested, charged or convicted of a misdemeanor or felony offense? If yes, please explain.
As part of the interview process to become a volunteer, Silverleaf will complete a criminal background check on all applicants.

I am available for training:

during the dayduring eveningweekends onlyanytime

References

1. Reference

First Name:

Last Name:

Phone:

Address:

2. Reference

First Name:

Last Name:

Phone:

Address:

Military

Have you served in military service branch?

YesNo

If yes, from what dates:

Why would you like to volunteer with Silverleaf Sexual Trauma Recovery Services?

By checking here, I hereby attest that the above information is true to the best of my knowledge.

Date

About Us

Silverleaf Sexual Trauma Recovery Services is a non-profit organization dedicated to reducing the trauma experienced by victims of sexual abuse and sexual assault.

Funding is in whole or in part from federal, CHFS, or other state funds.

Connect

Contact Us

Main Office

751 S Provident Way

Elizabethtown, KY, 42701

Satellite Offices
124 E White Oak St
Leitchfield, KY 42754

324 E. Main St.
Springfield KY 40069

Toll Free: 1-877-672-2124

Phone: 270-234-9236

Fax: 270-234-8367

Email: contactus@silverleafky.org