Volunteer/Internship Application

Name:_____________________________________________

Home Address:_______________________________________City__________________

State:______________Zip Code____________ Email______________________________

Telephone:_______________________Cell phone/pager____________________________

Are you now, or have you ever been registered in NY State Child Abuse registry clearinghouse or any other state?

Please Check one  Yes__________  No_________

Please Check all that apply:

Volunteer_________   Intern __________

Please indicate program interest.  Check all that apply.

___Administration            ____Helpline                ____ Rape Services

___Compeer                    ____Hudson House     ____ Young Adult Social Club

___Crisis Services            ____Fundraising

___Home-to-Stay            ____Invisible Children's Project

Time Availability:____________________________________________________________________
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Please state briefly what experiences you would like to gain from being a volunteer or intern:

_________________________________________________________________________________
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Graduation Date:_________________________College/University_____________________________

Department/Major___________________________________________________________________

Field Supervisor_____________________________________________________________________

Address___________________________________________________________________________

City_______________________State__________________ Zip Code__________________________