Volunteer Application

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Phone*

Email*

Emergency Contact Name*

First Last

Emergency Contact Relationship*

Emergency Contact Phone*

How did you hear about NAMI St. Louis?*

Are you a member?*

Yes
No

What is your membership preference?*

Open Door - $5
Individual - $40
Household - $60

What do you hope to receive from this experience?*

Previous Volunteer Experience*

Hobbies/Skills/Interests*

Why are you interested in the issue of mental illness?*

What volunteer tasks interest you?*

What days/time are you available?*

Would you be willing to be called on short notice to volunteer*

Yes
No

Reference Name*

First Last

Reference Phone Number*

Consent*

I have read and agree to the following volunteer policy.

I expect to be informed of in-service training opportunities. I expect to be informed of job descriptions and supervisors for specific volunteer tasks. I hold harmless from liability NAMI St. Louis and its staff for any injury which might occur during volunteer activities. I give consent for background checks as deemed necessary for volunteer activities. I understand that I may seek assistance from the Outreach Specialist if problems arise in the performance of my volunteer duties which I cannot resolve with the staff.

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Volunteer Application

Volunteer Application

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