• General Information:

• Please include at least one phone number where we can reach you during business hours and an email address that you can check frequently. Your Information is confidential.
  * First Name:
• * Middle Name:
• * Last Name:
• * Street Address:
• * City:
• * State
• * Zip:
• * Home Phone:
• Okay to Call me here:

  • Yes

• * Work Phone:
• Okay to Call me here

  • Yes

• * Cell Phone Number
• Okay to Call me here

  • Yes

• * Email Address:
• Date of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912
• * Gender:
• What kinds of email would you like to receive:

  • Electronic newsletters

  • Volunteering Opportunities

• Volunteer Agreement

• As a volunteer for Impact NW I agree to give time and services without financial compensation. In addition, I will not accept monetary gifts from Impact NW clients. I am committed to assist Impact NW in its mission, to enrich services to others, and to provide personalized assistance.
  
  

  • By this agreement I assume certain responsibilities:
  • RESPONSIBILITIES:
  • 1. To work in a professional manner.
    2. To keep confidential matters confidential.
    3. To immediately report abuse or signs of abuse (if observed) to an Impact Northwest staff member.
    4. To inform my Supervisor or the Community Involvement Manager (or staff person when applicable) when I am unable to volunteer at the arranged times due to illness or emergency.
    5. To be in on-going communication with the Volunteer Coordinator or Community Involvement Manager
    6. To promptly submit the required reports of volunteer hours performed.

  
  
  I acknowledge that my image, picture, and likeness may be photographed and/or recorded to be included in Impact NW’s various promotional materials. Impact NW shall own all rights, title and interest, including the copyright, in and to any photos or recordings made. By my presence as a volunteer, I grant my permission for my likeness and voice to be used by Impact NW without compensation, credit or other consideration.
  * Initial Here:

• Background Check Information

• I certify that the information in this Volunteer Application is true, correct and complete to the best of my knowledge. I authorize Impact NW to verify any and all information I provided by contacting appropriate sources. I understand that for the protection of visitors, volunteers and staff, all adults (age 18 and up) must voluntarily authorize a background check and I hereby authorize such background check. For anyone under 18 years of age, parents or legal guardian will voluntarily submit to a background check.
  * Initial Here:
• Do you know of any reason(s) that you might be able to obtain a clear background check? if yes, please explain briefly.
• Will you be driving on behalf of Impact Northwest?

  • Yes

  • No

• * If yes, Driver's License Number & Issuing State:
• * Race:
• Have you been arrested for a crime for which there has no been an acquittal or dismissal?
  • Yes

  • No
• Have you ever been convicted of any crime except for minor traffic violations?
  • Yes

  • No
• If yes, in what state(s) were you convincted?

• Waiver and Release of Liability

• I hereby waive any right or cause of action arising as a result of my participation in Impact NW??s volunteer projects, including transportation if provided, from which any liability may or could accrue against Impact NW or the staff, volunteers, or clients, collectively or individually. Without limiting the generality of the foregoing, I agree that this waiver shall include any rights or causes of action resulting from personal injury to me or damage to my property sustained in connection with my activities for Impact NW??s volunteer projects & positions. My signature to this volunteer liability release attests to my intent to hold harmless and release from all liability Impact NW or any of its staff, volunteers, or clients, from all acts which are related to the normal performance of required and implied duties.
  * Initial Here:

• Volunteer Confidentiality Agreement

• Information about Impact NW clients, their families and their personal lives should be kept confidential. Anything the client shares with you cannot be shared with your friends, family or associates without permission from the client. This also includes not speaking to other professionals (including school counselors, therapists, and teachers, among others) about Impact NW clients without first obtaining a release of information from the Volunteer Coordinator or Community Involvement Manager. By signing this form, you agree to respect their privacy.
  
  The following reasons are the only exceptions to this rule:

  • In a medical emergency you may provide information to the medical personnel who will be dealing with that emergency, only to the extent necessary to meet that emergency.
  • If you suspect or know of any child, elder, or person abuse or neglect you must report it to Impact NW staff within 24 hours. Impact NW staff will report the information to the appropriate protective services.
  • To prevent an immediate act of violence you must call 911.

  
  
  If any of these situations occur, it is important that you notify your supervisor or appropriate person(s) as soon as possible.
  
  By initialing where indicated and signing below, I understand that I am indicating my agreement with the terms of this application and all four preceding sections.
  * Initial Here:
• * Signature:
• Date: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912
• Guardian Signature (If Minor)
• Date: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912

• Emergency Contact Information

• We will attempt to contact the following person in the event of a personal emergency.
  * First Name:
• * Middle Name:
• * Last Name:
• * Street Address:
• * City:
• * State:
• * Zip:
• * Day Phone:
• * Evening Phone:
• * Cell Phone:
• * Relationship

• Physical Capabilities or Limitations

• Do you have any physical limitations (difficulty standing, lifting, hearing, etc.) that we should be aware of?
  If so, please describe briefly:

• Availability

• Please indicate the days and time periods that you are generally available to serve. You may provide additional information regarding your availability in the space below.
  Morning

  • Sun

  • Mon

  • Tue

  • Wed

  • Thu

  • Fri

  • Sat

• Afternoon:

  • Sun

  • Mon

  • Tue

  • Wed

  • Thu

  • Fri

  • Sat

• Evening:

  • Sun

  • Mon

  • Tue

  • Wed

  • Thu

  • Fri

  • Sat

• The dates I am available are:
  * From: * To:
• * Education:
• * Major Degree:

• Occupation

• * Employer/Company Name
• * Supervisor First & Last Name:
• * Street Address:
• * City:
• * State:
• * Zip
• * Phone
• * Website:
• Does your employer have matching gift program?
  • Yes

  • No

• Professional Skills and/or Special Abilities

• Please indicate any of the following skills or abilities that you possess. (Professional experience is not requires.) If you have other skills or abilities that might be valuable to Impact NW operations, please list them in the space provided.

  • Acting

  • Editing/Proofreading

  • People Skills

  • American SIgn Language

  • Electrician

  • Photography

  • Animal Care

  • Filing

  • Sight Guide / Visually Impaired

  • Artistic Ability

  • Food Service

  • Special Events

  • CDL (w/ passenger endorsement)

  • Foreign Language (list below)

  • Teaching

  • Clerical

  • Landscaping / Grounds

  • Warehouse

  • Construction / Fabrication

  • Maintenance / Repair

  • Writing

  • Data Entry / Keyboarding

  • Mechanic (specify below)

• Additional skills or abilities:

• Position you are applying for

• *

• Site / Location

• *

• Personal References

• List two non-family references who have known you for at least one year. Please provide at least one phone number for each reference.
  
  Reference One:
  * First Name:
• * Last Name:
• * Title:
• * City:
• * State:
• * Email Address:
• * Contact Number:
• * Relationship:
• Reference Two:
  * First Name:
• * Last Name:
• * Title:
• * City:
• * State:
• * Email Address:
• * Contact Number:
• * Relationship:

Privacy Policy

All transactions are in US Dollars. Donations may be refundable upon written request.