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Volunteer Opportunities

First name	Last name
Address
City	State Zip
Phone	Alt. phone
Email

Emergency Contact		Phone
Your Employer		Your Position

Are you a parent or family member of a child or children with a mental, emotional or behavioral disorder?
Yes
No

Where did you hear about IDFFCMH?

Have you been convicted of a felony?
Yes (If Yes, please explain: )
No

Please list the days, times, and # of hours per week you are available to volunteer:

Why are you interested in volunteering for IDFFCMH?

Please tell us how your skills, experience or knowledge related to children's mental health can help you in this volunteer position:

In what areas are you interested in volunteering?(for example: computer, telephone, advocacy, fundraising, etc.)?

To help us get to know you better, please assess your ability and/or experience in the following:
(1=Little....5=Great)

	1	2	3	4	5
Ability to provide education and information to families
Willingness to advocate in a variety of settings
Ability to participate and facilitate trainings
Willingness to be a representative/spokesperson for IFFCMH
Knowledge of children's mental health services
Knowledge of educational rights for children with special needs
Ability to maintain confidentiality of families served
Ability to participate and facilitate support groups

What training, resources or support do you anticipate needing to do this volunteer work?

Please provide two personal or professional references:
1. Name Phone Relationship
2. Name Phone Relationship

We are establishing a support network for families of children with emotional, behavioral or mental disorders in your area. Would you like to be part of this network?
Yes
No

Are you willing to have your name and contact information released to other families?
Yes
No

I understand that the IFFCMH conducts background checks on all volunteers. I hereby attest that the above information is true to the best of my knowledge.

Volunteer Signature Date