Volunteer Application

Area of Interest
I am interested in working with

Personal Information

Prefix
First Name
Last Name
Country
Address Line 1
Address Line 2
City
State
Postal Code
No file selected

Employment/School Information

General Information

How did you learn about Abbott House’s volunteer/mentor program?
Have you volunteered for any other agencies before?
If yes to the question above, please list:
In what area are you able to volunteer? (Check all that apply)
What languages are you comfortable speaking?
What days are you available to volunteer? (Please check all that apply)
What times are you available to volunteer? (Please check all that apply)

References

Please provide the name, phone number, and email address for 1 professional reference

Professional Reference

I agree to keep all details of treatment, past history, and current functioning of all adults, children, and families under  Abbott House’s care confidential and will not disclose any information to any person who is not either an AH staff member or a person specifically approved by AH. Confidential information relating to staff and agency business must not be discussed with unauthorized persons.

I certify that all of the above information is true and accurate and give my permission for Abbott House to contact the aforementioned references and employer.

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If you are 15 or under please ask your parent or legal guardian to provide his or her name in the box below, along with his or her email address:

By placing my name in the box below, I am confirming that I am the parent or legal guardian of the volunteer applicant and I authorize the volunteer applicant to work at Abbott House as an unpaid volunteer:

*An FBI fingerprint check, DMV check, clearance from NY State Central Registry (SCR) and a drug and TB screening are required for any individual volunteer/Mentor involved in unsupervised interactions with youth and developmentally disabled adults.  All background information will be kept confidential.  Acceptance into the program is based on the sole discretion of the agency and may be terminated at the discretion of the Development or Human Resources departments.