Married Divorced Single
List Your Employment/Training Background:
List Any Previous or Current Volunteer Experience:
Please provide the name and phone number of two additional references that you have known at least 5 years. Someone not related to you and not a previous employer .
Where do you attend church? We will be contacting your pastor for a reference. Please provide the following information:
Under what circumstances would you consider abortion as an option?
Never an option Known birth defects If a woman feels that is her best option In cases of rape Incest In cases of extreme psychological stress Other
How would you rate your knowledge of how abortions are performed/methods used to perform abortions?:
Excellent Good Fair Poor
I would like to do the following:
Baby Boutique Counseling Various Clerical and Administrative work Bulk Mailings Host a Baby Bottle Drive Host a Life Party Maintenance Fundraising Events Prayer Team Providing materials by donating or recruiting donations Graphic Art Copywriting Photography Social Media Marketing Walk for Life (WFL) Coach Cleaning
I would like to provide professional services:
MD, PA, NP Nurse, Ultrasound tech Clergy Attorney
Number of hours available to volunteer each week: (minimum of 4 hours/day required for counseling, 4-8 hours/week recommended)
4-8 9-13 14-17
Clinic Hours Are: Mon/Tues/Wed/Thurs: 9am-4pm, Fri 9:30am-12:30 pm, and Sat 9:30am-12:30pm (by appointment only)
Please list the time frames you are available to volunteer. We require at least 4 hour time slots per each volunteer visit (ie 12pm-4 pm or 10am-2 pm). If there are no appointments for Saturday, you will not be asked to come in.
When I first saw Charlotte, I noticed how frightened she appeared so I attempted to make her feel as comfortable as possible. As we spoke in the counseling room, she had expressed all of her fears and the personal goals she had set for her life.
Your partnership is so critical as we continue to provide free services to the community. As a financial partner, you can make a big difference in the lives of women and children.