Volunteer Application Form for NWAHR

Northwest Arkansas Harm Reduction

Volunteer Application Form
Northwest Arkansas Harm Reduction (NWAHR) is working to create a community that values the safety and dignity of all people through compassion and understanding of individuals through evidence-based harm reduction practices.

We encourage the participation of volunteers who support our
mission and are willing to contribute. The information provided through this form will be kept confidential and will help us determine the
most satisfying and appropriate volunteer opportunity for you.
Name*

First NameLast Name
Birth Date*

MonthDayYear
Email*
example@example.com
Phone Number*
Address (Please provide for emergency records)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Educational Background
College/School
Department/Field
Occupation
Company
Department/Position
Social Media Handles
Facebook
Instagram
Emergency Contacts

(this will be required prior to volunteering)
Name (first and last, relationship)
Contact Number
Name (first and last, relationship)
Contact Number
Name (first and last, relationship)
Contact Number
Which area(s) are you interested in volunteering?*

Market ResearchProgram developmentHarm Reduction Advocacy/Public SpeakingSupply DistributionEvents (NWAHR Hosted)Events (Other hosted/tabling/education)Other
Do you have any volunteering experience? If yes, please describe.
Select your available days

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundays
From

Hour Minutes

AM/PM Option
To

Hour Minutes

AM/PM Option
Additional notes about your schedule or other inquiries or concerns you may have.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Northwest Arkansas Harm Reduction

Educational Background

Occupation

Social Media Handles

Emergency Contacts