**PLEASE fill out and print
Application to: Volunteer Intern - # hours required
Community Service - # hours required
Valley AIDS Information Network, Inc. (VAIN) is excited that you are interested in becoming a volunteer or Intern. We will do our best to match your areas of interest with our current volunteer opportunities. Please PRINT out and answer all questions if more room is needed, add additional pages. You can also SCAN this completed application and send to Volunteer@valleyAIDSInfo.org
These questions will help us find a mutually rewarding team position. Should you have any questions please contact: VAIN’s Volunteer Coordinator at 541 752-6322 or by email: Volunteer@ValleyAIDSInfo.org
First Name M/I Last Name
City Zip Code
Date of Birth: yyyy/mm/dd
Home Phone Cell Phone Work Phone
Emergency Contact Name
Emergency Contact’s Phone
Why would you like to volunteer with VAIN?
How often are you available? Daily Weekly Bi-Weekly Monthly
What days are you available?
Time available? Mornings Afternoons Evenings Other_________
Do you speak Spanish?
Do you have a valid Drivers License
Do you have Insurance?
Have you previously volunteered, or worked for any non-profit organizations?
City State Zip
(yyyy/mm/dd) End Date
Have you personally helped or worked directly with any persons who were either HIV-positive or had an AIDS diagnosis?
If yes, please describe
Do you have experience with special needs clients?
Please select each type of Client you have experience working with:
Alcoholic(s) Drug Addict(s) IV Drug Users Homeless
Undocumented Immigrant(s) Incarcerated Individual(s)
High Risk Youth High Risk Adults MSM (men who have sex with men)
Please read VAIN’s current Volunteer opportunities and list specific position(s) you would like to apply for:
What experience or skills do you have that will help you volunteer at VAIN?
High School Graduate?
Degree(s) or Certificates Earned:
Other Degree(s) or Certificate(s) Obtained:
I am Currently Employed:
Name of Employer
City State Zip
Where did you here about VAIN? School Work TV Radio Family Friend Other (please list)
From time to time people seeking assistance from VAIN, while accessing resources, referrals, information, or assistance, will disclose their HIV status, medical condition(s), medical treatment, history of drug or alcohol treatment, sexual orientation, or gender identity to members of VAIN. I understand that VAIN’s highest priority in these instances is the assurance of the confidentiality of the organization’s clients and volunteers in regards to their personal information. Under no circumstances will I divulge the personal information of anyone who contacts or otherwise utilizes VAIN and its resources or programs. In the extraordinary event that it becomes necessary to reveal this information, I will first consult with a member of VAIN’s Board of Directors. I understand that violation of this policy, i.e., “outing” a client or VAIN volunteer, without his/her prior permission, or the permission of a member of VAIN’s Board of Directors, may result in an investigation by the Board of Directors, and the findings may result in possible termination or even prosecution as applicable under Oregon and Federal law.
Equal Opportunity & Discrimination Polices: Volunteer opportunities are open to all qualified applicants, solely on the basis of their interest, experience, knowledge, skills and abilities. Qualified applicants are considered for all open positions for which they apply and for advancement without regard to race, color, religion, gender, gender expression, sexual orientation, national origin, age, marital status, or the presence of a medical condition or disability. VAIN will not tolerate any form of discrimination, harassment or retaliation affecting its clients, volunteer’s or applicants due to race, color, religion, gender, gender expression, sexual orientation, national origin, age, marital status, medical condition, or disability.
By affixing your signature, you hereby understand and agree to abide by both VAIN Confidentiality & Discrimination Policies.
Witnessed By Date