BLACK COALITION FOR AIDS PREVENTION (BLACK CAP)

VOLUNTEER APPLICATION FORM

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A – CONTACT INFORMATION:

First Name ______Last Name______

Address ______Apt #______

City ______Province______Postal Code______

E-Mail ______

Home Phone______(can we leave a detailed message about who we are: Yes /No)

Work Phone ______

Languages spoken:English French Other ______

Languages written:English French Other ______

Emergency Contact Name ______Phone ______Relationship______

B – KNOWLEDGE ABOUT BLACKCAP:

How did you learn about Black CAP?

From Newspaper, Magazine, Television Health Care ProviderTelephone Book

Referral from another Agency/LawyerBlack Cap PamphletsWord of Mouth

Volunteer/employment centreInternet/web-siteBlack CAP Staff

Why do you want to volunteer for Black CAP? (Check all that apply)

Support the causeMeet new people

Apply skillsCommunity service Other______

Develop skillsInternship

C – SKILLS PROFILE:

Occupation ______Employer (Optional) ______

Previous/present volunteer or work experiences______

What skills would you apply in a volunteer role with us?

Administrative skillsWriting/editingFundraising

Community OutreachGraphic DesignEvent Planning

Workshop Facilitation Word ProcessingSpecial Events Promotion

Practical SupportDesktop PublishingTranslation/Interpreter Service

Leadership skillsMediaOther______Please turn-over

D – VOLUNTEER OPPORTUNITIES:

Please check your area(s) of interest. Indicate your preference by ordering them #1, 2, 3, etc.

Administration/ReceptionEvent/PlanningCommittee Work

Club/Bar/BathhouseSupport DepartmentBoard of Directors

General OutreachEducation/PreventionImmigration & Settlement

FundraisingHarm ReductionLGBT

E – AVAILABILITY:

Please mark below (√) the days/times you are available to volunteer

Time of Day / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
Morning
Afternoon
Evening

F – REFERENCES:

Please provide the name of personal or professional reference

Name ______Phone ______Relationship______

G – VOLUNTEER AGREEMENT:

At all times, the privacy and dignity of clients, donors, volunteers and staff will be respected, and the mission, vision and philosophy of the Black Coalition for AIDS Prevention will be followed in accordance with the Black CAP’s policies, standards and guidelines. As a volunteer of the Black Coalition for AIDS Prevention, you may have access to information and documents relating to clients, donors, volunteers and staff that are private and confidential in nature. All volunteer and client records are the property of Black CAP and will be treated as confidential material; reasonable care and caution should be exercised to protect and maintain total confidentiality. No person shall read records or discuss such information unless there is legitimate purpose. Volunteer and client interactions shall not be discussed with people outside Black CAP, including immediate family members, throughout and beyond tenure with Black CAP.

By signing below, you acknowledge that the information provided is true and accurate, and that you have read, understand, and will abide by the agreement above. And, by signing below, you grant the Black Coalition for AIDS Prevention permission to contact the references listed.

Signature ______Date ______

Signature of Parents/Guardian (if under 18years old) ______Date ______

OUR POLICY:

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual orientation, age or disability.

RETURN BY MAIL, FAX, EMAIL OR HAND TO:

Black Coalition for AIDS Prevention

20 Victoria Street, 4th Floor

Toronto, ON M5C 2N8

Fax: 416-977-7664

Email

Thank you for completing this application form and your interest in volunteering with the Black Coalition for AIDS Prevention.