Supplemental Volunteer Application

Please submit information for this form if you will be conducting advanced mental health screenings or information.

Full Name

Home Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Daytime Phone

Information About You:

Highest Level of Education

Employer, if applicable

Special training, skills, or hobbies

Groups, clubs, or organizational memberships

Please describe your prior volunteer experience

What experiences have you had that may prepare you to work as a volunteer in the fields of mental health, outreach,advocacy, and underserved populations?

Why do you want to volunteer for MHA?

Do you have a driver's license?

Do you have car insurance?

Do you have a car available for transporting others?

Please provide the following information for a reference:

Reference Name

Relationship to you

Length of relationship

Phone number

Please read the following carefully before submitting this application:

I understand that this is an application for and not a commitment or promise of volunteer opportunity. I certify that I have and will provide information throughout the selection process, including on this application for a volunteer position and in interviews with Mental Health America that is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would unfavorably affect my application for a volunteer position. I understand that information contained on my application will be verified by MHA. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant for a volunteer position with MHA or my termination as a volunteer.

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