Austin Mental Health Community Volunteer Application
3205 South 1st Street Austin, Tx 78704 • Main (512)442-3366 • Fax (512)448-3366
Date
-
Month
-
Day
Year
Date
Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail:
*
Contact number:
*
I am over 18
*
Yes
No
Have you had a chance to visit Austin Mental Health Community before?
Yes
No
How many hours a week do you want to volunteer?
*
Do you have reliable transportation?
*
Yes
No
Please list your hobbies/interests that could benefit AMHC and its members:
Check as many talents/skills that apply to you:
Data Entry
Fundraising
Public Speaking
Phone Duties
Grant Writing
System Advocacy
Computer/Internet
Web Design
Facilitating Groups
Peer Advocacy
Outreach
MS Office
Other
Emergency contact person:
First Name
Last Name
Emergency contact person relationship to you:
Emergency contact number:
Do you have any disabilities, health conditions, or specific accessibility needs we should be aware of? If so, please let us know:
How did you hear about Austin Mental Health Community?:
Upload Your Files
Attach Resume / ID
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of
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*
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