Planned Parenthood - Volunteer Program Application

Español

Health Glossary

Store

Administrative Office
26 Bleecker Street
New York, NY 10012-2413

Who We Are

Español

Our Health
Services

Local Education &
Training

For Parents &
Teens

Get Involved
Locally

Local News &
Events

HIPAA Privacy Policy

Get Involved
Locally

Donate Locally

Take Action Online Now!

Our Legislative Agenda

Meet Other Activists

Elections & Voting

Volunteering & Internship Opportunities

Fun Stuff

Community Advisory Boards

Religious Leaders Task Force

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, 5th Floor
New York, NY 10012
Attention: Associate Director, Human Resources

RESUME - PLEASE UPLOAD RESUME BEFORE FILLING IN THE APPLICATION

(allowed file extensions: .doc .pdf .txt)

PERSONAL INFORMATION (CONFIDENTIAL)

Name:

Date:

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:

End:

School name: Degree:

Area of study:

Internship objectives:

Please include any information on your school’s internship requirements and learning goals

PREVIOUS VOLUNTEER EXPERIENCE

1. Organization:

Dates: From:

To:

Position and Duties:

2. Organization:

Dates: From:

To:

Position and Duties:

3. Organization:

Dates: From:

To:

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

Health Center Escort
Client Advocate
Recovery Room
Health Center 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