* indicates a required field

Name, Address & Contact Info

First Name*
Last Name*

Birth Month:—Please choose an option—JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay:—Please choose an option—12345678910111213141516171819202122232425262728293031

Phone*
Email*

Street Address

City
State
—Please choose an option—DCMDVA Zip Code

Employer or School

Emergency Contact Info

Name*
Relationship
Preferred Phone*

Application Basics

Have you had any previous involvement with NVFS?
—Please choose an option—YesNo

If yes, in what capacity?

Why do you want to volunteer at NVFS?
To select more than one, hold "Ctrl" as you click.
Contribute my skillsLearn new skillsConnect with othersUnderstand community needsFill unmet needsSchool requirementCourt requirement

If you are applying for a specific position or type of work, list here.

Language Skills

Do you speak Spanish?IntermediateAdvancedFluentNative LanguageNo

Do you speak any languages besides English or Spanish?

Language:
IntermediateAdvancedFluentNative Language

Language:
IntermediateAdvancedFluentNative Language

Availability

Location (Select all that apply)
Arlington CountyFairfax CountyLoudoun CountyPrince William CountyRemote/Virtual

Days & Hours Available to Volunteer:
Sunday: MorningAfternoonEvening

Monday: MorningAfternoonEvening

Tuesday: MorningAfternoonEvening

Wednesday: MorningAfternoonEvening

Thursday: MorningAfternoonEvening

Friday: MorningAfternoonEvening

Saturday: MorningAfternoonEvening

How frequently would you like to volunteer?
WeeklyBi-weeklyMonthlyOccasionally

Interest Areas

What are your volunteer interest areas?
To select more than one, hold "Ctrl" as you click.
AdministrativeAdultsChildrenClient assistanceCommunications/marketingCooking/food servicesEmployment assistanceEventsEvent planningFinance/accountingFood warehouseFundraisingHealth access enrollmentInterpreting/translatingITJob skills trainingManual laborPublic assistance enrollmentReception

Skills, Talents & Hobbies
Special skills, talents and interests you want to use in your volunteer role and/or things you do well and enjoy doing. List anything that comes to mind. You'd be surprised how your talents can be utilized.

Learning Quests
Areas you would like to learn more about for professional or personal development. List areas of interest you may not have the skills to perform but that you would like to learn.

No-No's
"Please don't ask me to do this!" List anything you really don't want to do.

Additional Information

Have you ever been convicted of a crime? (Crime can be defined as an action prohibited by law or a failure to act as required by law). A conviction will not necessarily result in the denial of volunteer service. YesNo

If yes, please explain:

References

I authorize these three (3) references to disclose requested information about me to NVFS and I authorize NVFS to obtain information about me from these references (please do not use family members). Additionally, I will provide this NVFS Volunteer Reference Form to the following references:

1. Name: Relationship: Email:

2. Name: Relationship: Email:

3. Name: Relationship: Email:

Electronic Signature

CONFIDENTIALITY: As a volunteer with Northern Virginia Family Service (NVFS), I understand that any staff, client, volunteer or project-related information (written or verbal) for which I gain knowledge must be held in strictest confidence and not shared outside of NVFS. I will respect the rights and privacy of all information pertaining to written consent of the appropriate NVFS authority.

PRIVACY OF INFORMATION: I understand that the information I have disclosed on this form will remain confidential to NVFS. Furthermore, I understand that, by providing my email, I will be subscribed to the monthly Volunteer Voice and NVFS Insider e-newsletters and will have the option to unsubscribe should I so choose.

RELEASES: NVFS’ priority is the safety of our clients and program participants. In order to ensure the safety of NVFS participants, NVFS reserves the right to conduct background checks on volunteers, who will work with children, or may come in contact with children during the course of their volunteer experience. Such individuals will be required to maintain satisfactory records as a condition of volunteerism. In addition, NVFS may periodically perform background checks on volunteers who have been previously checked and who continue to be involved in a position with NVFS whereby NVFS policy would require such background checks of such individual. I hereby release NVFS from all liability for any damage whatsoever incurred in obtaining or furnishing such information.

By signing my name and dating this authorization, I hereby confirm the accuracy of the information provided above and grant NVFS the permission to do a background check, as NVFS deems necessary.

Based on the above, I agree to indemnify and hold harmless and release NVFS and its officers, employees and authorized representatives from and against any and all liability, loss, damage, costs (including attorney’s fees) arising out of or in any way attributed to the activities performed as an NVFS volunteer.

Furthermore, I give permission to NVFS, and/or parties designated by NVFS, to record the story and/or likeness of the person(s) named below and use such accounts in all forms of media, for any and all promotional purposes including brochures, television interviews, NVFS reports/press releases, radio/newspaper/newsletter interviews, photos, public service announcements, fundraising appeals, video production, NVFS website, social media sites and related internet marketing indefinitely, unless or until I revoke this permission in writing.

E-Signature*
If you are under 18, e-signature of parent/guardian