Safe Haven

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Volunteer

Basic Information
Name*
First Last
Pronouns
Example: She/her; he/him; xe/xem
Email*

Phone*
Address
Street Address Address Line 2 City State ZIP Code

Date of Birth*
Safe Haven volunteers must be over 18 years old for certain tasks.
Month
Day
Year

Who is your employer and what is your title?
Is your volunteer time a requirement for a class or other community service?*
Yes
No
Required Volunteering
Note that becuase of the shorter time-frame that comes with these types of volunteer experiences, volunteers that are completing hours for a class will not have direct client or youth contact.
School/Program Name*
Instructor/Supervisor's name, title, contact information*
How many total hours are required?*
Required completion date
Volunteer Availability
In general, what time(s) would you be primarily available to volunteer? NOTE: Priority is given to those that can volunteer Monday-Friday 8am-4pm.
Monday
Morning (8am-noon)
Afternoon (noon-4pm)
Evening (4-8pm)
Not Available
Tuesday
Morning (8am-noon)
Afternoon (noon-4pm)
Evening (4-8pm)
Not Available
Wednesday
Morning (8am-noon)
Afternoon (noon-4pm)
Evening (4-8pm)
Not Available
Thursday
Morning (8am-noon)
Afternoon (noon-4pm)
Evening (4-8pm)
Not Available
Friday
Morning (8am-noon)
Afternoon (noon-4pm)
Evening (4-8pm)
Not Available
Saturday
Morning (8am-noon)
Afternoon (noon-4pm)
Evening (4-8pm)
Not Available
Sunday
Morning (8am-noon)
Afternoon (noon-4pm)
Evening (4-8pm)
Not Available
Can you commit to volunteering at a regular scheduled time?
Background, experience, knowledge, skills and interests
Why would you like to volunteer with Safe Haven?*
List any skills, training or experience you would bring to this volunteer opportunity.*
Have you or an immediate member of your family received services from Safe Haven in the last 24 months?*
Have you ever been convicted of a misdemeanor or a felony?*
Yes
No
Please provide dates and nature of crime.
Volunteer Interest
Let us know your interest in different volunteer activities.
Cleaning
Interested
Not Interested
I'd like to learn more
Organizing
Interested
Not Interested
I'd like to learn more
Dinner Service
Interested
Not Interested
I'd like to learn more
Child Care
Interested
Not Interested
I'd like to learn more
Event
Interested
Not Interested
I'd like to learn more
Fundraising
Interested
Not Interested
I'd like to learn more
If you have a special talent that you would like to share, let us know here:
Reference Check
Some of our volunteer positions have the potential of client interaction, because of that, we will need some references if/when you end up volunteering in those roles.
Name*
First Last
Relationship*
Relationship*
Email*

Phone*
Phone*
Name*
First Last
Relationship*
Email*

Phone*
Consent*
I fully understand that misrepresentation or omission of facts called for in this application is cause for dismissal. I understand that to ensure the safety of clients, it is the policy of Safe Haven Shelter and Resource Center to complete a background and reference checks on all potential volunteers and acceptance into the volunteer program is contingent upon its satisfactory completion.
I give Safe Haven Shelter and Resource Center consent/permission to contact my references.

First Name*
Last Name*
Email*

SAFE HAVEN
SHELTER

P.O. Box 3558
Duluth, MN 55803
P: (218) 728-6481
F: (218) 728-5084

SAFE HAVEN
RESOURCE CENTER

414 W. 1st St.
Duluth, MN 55802
P: (218) 623-1000
F: (218) 623-1006

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Safe Haven Shelter and Resource Center does not discriminate on the basis of race, color, creed, national origin, religion, sex, affectional orientation or gender identity, political affiliation, marital status, status with respect to public assistance, disability, or age in the delivery of services or employment practices.