Volunteer Program Application

Please complete this application and submit it online, along with a copy of your resume. Or mail both to:

Planned Parenthood of New York City—Volunteer Program
26 Bleecker Street, 6th Floor
New York, NY 10016
Attention: Volunteer Coordinator
PLEASE UPLOAD ANY FILE(S) BEFORE FILLING IN THE APPLICATION
Resume - Please upload resume

(allowed file extensions: .doc .pdf .txt)
Please upload any documents with information on your school's internship requirements and learning goals.

(allowed file extensions: .doc .pdf .txt)
PERSONAL INFORMATION (CONFIDENTIAL)
Name:   Date: calendar icon
Address:
City:   State:   Zip:
Phone: (day) (evening) (Cell)
E-mail    Fax:
Best time to contact you:   Are you over 18 years of age?
Are you interested in:
Volunteer service
Internship
Community service to fulfill a requirement
How did you hear about Planned Parenthood of New York City?
If you have volunteered for Planned Parenthood, state where/when last position and reason for leaving:
Why are you interested in volunteering with Planned Parenthood of New York City?
What would you like to gain from your experience as a Planned Parenthood of New York City volunteer?
INTERNSHIP/COMMUNITY SERVICE INFORMATION
(ONLY COMPLETE IF THIS IS RELEVANT FOR YOU)
Student status: Full time Part time
Are you doing your internship for school credit or to meet class requirements?
If so, how many hours are required?
Time commitment?   Start: calendar icon      End: calendar icon
School name:   Degree:
Area of study:
Internship objectives:
PREVIOUS VOLUNTEER EXPERIENCE
1. Organization:
Dates:   From: calendar icon      To: calendar icon
Position and Duties:
2. Organization:
Dates:   From: calendar icon      To: calendar icon
Position and Duties:
3. Organization:
Dates:   From: calendar icon      To: calendar icon
Position and Duties:
REFERENCES
 

Name

Title/relationship
to you

Organization/Agency

Phone number

1.
2.
3.
AREA(S) OF INTEREST
Please indicate the type(s) of volunteer opportunities that interest you:
Public Affairs
Advocacy/Public Information
Office Support
Community Events/Outreach
Other
Education
Media/Communications
Program Support
Other
Health Center
Client Liaison
Client Greeter
Recovery Room Assistant
Administrative Assistant
Other
Executive Office/Administration
Data Entry
Office Support
Special Events
Monthly Volunteer Nights
Other
SCHEDULING
Are you available: weekdays weekends?
Please indicate the times you would be available (check all that apply):
 

Morning
9am-12pm

Morning/
Afternoon
9am – 2pm

Afternoon
12pm-4pm

High School
Student
3pm-5pm

Evening 1
6-8:30pm

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday 2 N/A N/A
1 Only available once a month on Monthly Volunteer Night
2 Administrative office closed, but the health centers are open
Period of time you would like to commit:
Any seasonal, school, travel, or other scheduling difficulties:
OTHER INFORMATION
Do you have any special skills that you could use in a volunteer placement (word processing, research, counseling/medical training, etc.)
Do you have any language skills that you could use in a volunteer placement? Please list.
Do you have any special areas of interest that are relevant to a volunteer placement?
Would you like to join our mailing list of pro-choice advocates, the Planned Parenthood of New York City Action Network? Yes No
If so, visit www.ppaction.org/ppnyc/join.html.
Would you like to receive information from Planned Parenthood of New York City’s Development Department (e.g., special events and fundraisers)? Yes No

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