MamaMoon
Our Volunteers are the heart of this organization. Thank you for your interest in this program!
About You
Let's get to know a little bit more about you!
First Name
*
Middle Initial
*
Last Name
*
Contact Number
*
Can we text this number?
*
Yes
No
Email address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birth Date:
*
References
We require two personal references, non-family. Please make sure you reach out to the references that you provide here and let them know that we will be reaching out to them for a reference check.
Personal Reference #1 First and Last Name
*
Cell Phone Number that we are able to text
*
How do you know this person?
*
Personal Reference #2 First and Last Name
*
Cell Phone Number that we are able to text
*
How do you know this person?
*
Employment History
What best describes your employment situation?
*
Currently employed full time
Currently employed part time
Currently not employed
Other
If applicable, who is your current employer?
We will not contact your current or previous employers unless you use them for a personal reference.
Skills
This will help us match you with a new mother.
Please list any certifications that you have that might help on a visit with a new mother. (Doula, lactation, LLL, Infant CPR, etc.)
Please list any experience or training you have that might help on a visit. (Examples: breastfeeding, newborn care, PMAD, multiples)
Area
We require our volunteers to attend four visits a year, if the need presents in their area. We ask that you be able to travel up to 25 miles one way, and we will reimburse you for your travel at 14 cents a mile. Please check all areas that you are able to travel to.
Which chapter will you serve?
*
Chapter 1 - NY, Suffolk County
Chapter 2 - NY, Nassau County
Chapter 3 - NY, NYC
Chapter 4 - TN, Knox, Loudon, Blount, Sevier, & Monroe
Chapter 5 - TN, Anderson, Roane, Union, Campbell, Scott, & Morgan
Chapter 6 - TN, Claiborne, Hancock, Grainger, Hamblen, Jefferson, Cocke, & Hawkins
Chapter 7 - TN, Sullivan, Green, Washington, Unicoi, Carter, & johnson
Chapter 8 - TN, Chattanooga and surrounding
Chapter 9 - NY, Saratoga
Chapter 10 - PA, Philadelphia
Other
We give new mamas the option to have virtual visits via Zoom, instead of in-person. We also will transfer an in-person to virtual within 2 weeks if we are unable to fulfill the visit (if there is no one available to visit, or if there is a sickness). Are you able to do virtual visits via Zoom?
Yes
No
We follow up with our new mothers 2 weeks after their visit to see how they are doing. This can be either done via email, text, or phone. Are you able to help with follow up conversations?
Yes
No
More Information
The information in this section will not necessarily disqualify you as a volunteer.
Do you currently smoke?
*
Yes
No
To protect the vulnerable community that we serve, we run background checks on our potential volunteers. Is there anything that you want us to know prior to running a background check?
*
Have you ever been convicted of a crime? (if yes, please explain in detail):
*
This will not necessarily disqualify you as a volunteer with us.
Why are you interested in volunteering for the MamaMoon Program?
*
Are we missing anything? Any questions that we can answer for you?
*
By signing below, I certify all of the information on this application is true and correct to the best of my knowledge.
Submit
Should be Empty: