Guitars for Vets: New Chapter Application

Guitars for Vets: New Chapter Application
Applicant Information
Applicant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Birthdate*

MonthDayYear
Date

Chapter Information
Chapter Location*

Street Address

Street Address Line 2

CityState

Zip Code
Preferred Chapter Venue Name (Lesson Location)*
Example: VFW Post 142
Venue Type*
If you'd like to review the chapter coordinator roles and responsibilities, please click here: https://guitars4vets.org/how-to-start-a-chapter/
All chapters require a chapter coordinator. Are you interested in taking on the role as chapter coordinator?*

YesNoI'd like to assign someone else
As a G4V coordinator, you are responsible for managing a G4V email address, record-keeping, and local donor interaction. You may also be responsible for creating a relationship with the VA and scheduling students and instructors. Most coordinators dedicate between 1-3 hours a week to volunteer with Guitars for Vets. Are you willing to dedicate 1-3 hours a week for these responsibilities?*

YesNo
Do you have potential volunteer guitar instructors? If you plan on instructing, please click 'yes'.*

YesNo
All G4V Chapters must have a referral system. Veterans gaining entry into the program must have a referral from their VA provider, a qualified professional, or proof of service and service-connected disability. Do you have a referral system in place?*

YesNo
Why are you interested in starting a Guitars for Vets Chapter?*
If you have a VA Volunteer/Employee badge, please upload here.

Cancelof

Please include any questions or concerns you may have here

Terms and Conditions
Background Checks Agreement - I understand that passing a background check is a requirement to volunteer for certain positions with Guitars for Vets. I agree to allow the VA (Department of Veterans Affairs) or an agent designated by Guitars for Vets to perform this background check. All results will be kept confidential. Please note that signing this form is NOT your background check. You will be given the next steps upon approval.

Firearm Policy - For chapters located at VA locations: Pursuant to Department of Veterans Affairs CFR › Title 38 › Chapter I › Part 1 › Section 1.218 (a)(13) Weapons and explosives. “No person while on property shall carry firearms, other dangerous or deadly weapons, or explosives, either openly or concealed, except for official purposes.” For chapters located at non-VA locations G4V adheres to the state/local/venue firearms policy applicable to the venue in use. Any violation of this policy will be grounds for immediate termination.

Non-Disclosure Agreement - I understand that information that is shared by anyone participating in Guitars for Vets informational sessions, training sessions, meetings, discussions, and deliberations is to be treated as confidential. I further understand that printed information that is shared, whether electronically or on paper, must be kept, used, and destroyed securely, and that every caution must be taken to ensure that conversations and communications that include confidential information remain private. I have read and agree with this non-disclosure agreement and shall not disclose to any other party, or use for my own benefit or for the benefit of any other party, any Guitars for Vets information or materials without prior written approval from Guitars for Vets management. I also promise to not disclose or use for my own benefit or for the benefit of any other party any information I may learn about students in or graduates from the Guitars For Vets program. I understand that failure to comply with this agreement is grounds for legal action and/or removal from Guitars for Vets’ program.

Hold Harmless Policy - I agree to hold Guitars for Vets harmless for any physical, emotional or financial loss related to the Guitars for Vets program. I agree to indemnify Guitars for Vets for harm or loss it occurs as a result of any intentional, reckless or grossly negligent acts by me in relation to the program that harm another person or property.
Todays Date*

MonthDayYear
Date
Should be Empty:

Guitars for Vets: New Chapter Application

Applicant Information

Chapter Information

Terms and Conditions