Direct Service Volunteer

Personal Information
Name*
First Last
Phone*
Email
Address*
Street Address Address Line 2 City State ZIP Code
Would you like to receive occasional emails about our programs and events?
Yes, I would like to receive ABW updates

Student Information
For all students who wish to volunteer for class credit: We require a minimum of at least 25 volunteer hours. If you have any questions or concerns, please contact our Volunteer Coordinator at 765-747-9107.
Are you volunteering for class credit?*
- Yes
- No
School Name:*
Course Name:*
Instructor Name:*
Hours Required:*
Which semester are you wishing to complete the internship?
- Spring
- Summer
- Fall
- Other
Evaluation Required?*
- Yes
- No

Employment History
Please List all Previous Employment (most recent/current first)
Click the + to add additional employment.
Company Job Title Dates/Range

About You!
List hobbies, interests, leisure time activities:
Why do you wish to be an ABW volunteer?
Have you had any special training that might contribute to your work at ABW? If yes, please explain:
Have you had any personal experience that may contribute to your work at ABW? If yes, please explain :

Direct Services
ABW volunteers assist in all areas of direct services with clients and their children. These are the following services that we offer. Domestic Violence Crisis Intervention - Answering the telephone and handling domestic violence crisis calls as they arise. Intake - Meeting women/children at City Hall to assess and conduct the intake interview and paperwork prior to admission into the shelter. Advocacy - Any activity conducted on behalf of, or in support of clients and/or their children. Casework - Being available to spend time with the women who are in shelter. Possible peer counseling or just relaxing and visiting. Crisis Intervention - Answering phones and handling crisis calls of all types. (Training will be provided) Information Referral - Answering phone calls and providing information of all types. Telecare - Making daily calls to elderly, disabled, and shut-ins for social, safety check, and medication reminders.
Please indicate if you are more interested in performing indirect services (tasks which are not directly working with clients).
- Yes
- No
Indirect Service Interests:
Children's Activities
Volunteers spend some time with the children who are in shelter. You may volunteer for one of the children’s programs if you want to work exclusively with children.
Please indicate if you are more interested in children activities so that your schedule can be planned accordingly.
- Yes
- No

References
You will receive three reference forms to give to the people you use as references. Please list below the names and phone numbers of the people who will be providing your references. (Students should not use peers; instead list employers, instructors, long-time family friends, etc.)
Please list THREE references:*
Click the + to add additional references.
Name Phone Email (Required) Relationship
Emergency Contacts
Emergency Contacts*
Click the + to add additional contacts.
Name Phone Address Relationship
Comments
This field is for validation purposes and should be left unchanged.

Company	Job Title	Dates/Range

Name	Phone	Email (Required)	Relationship

Name	Phone	Address	Relationship

Personal Information