BLACK COALITION FOR AIDS PREVENTION (BLACK CAP)
VOLUNTEER APPLICATION FORM
_______________________________________________________________________________________
A – CONTACT INFORMATION:
First Name ___________________________ Last Name __________________________________________
Address __________________________________________________________________ Apt #__________
City _______________________________ Province______________________ Postal Code_____________
E-Mail __________________________________________________________________________________
Home Phone________________________________________ (can we leave a detailed message about who we are: Yes /No)
Work Phone _________________________________
Languages spoken:
English
French
Other ________________________________________
Languages written:
English
French
Other ________________________________________
Emergency Contact Name _______________________ Phone _____________Relationship_____________
B – KNOWLEDGE ABOUT BLACK CAP:
How did you learn about Black CAP?
From Newspaper, Magazine, Television
Referral from another Agency/Lawyer
Volunteer/employment centre
Health Care Provider
Black Cap Pamphlets
Internet/web-site
Telephone Book
Word of Mouth
Black CAP Staff
Why do you want to volunteer for Black CAP? (Check all that apply)
Support the cause
Meet new people
Apply skills
Community service
Other____________________________________
Develop skills
Internship
C – SKILLS PROFILE:
Occupation _______________________________ Employer (Optional) ______________________________
Previous/present volunteer or work experiences__________________________________________________
What skills would you apply in a volunteer role with us?
Administrative skills
Writing/editing
Community Outreach
Graphic Design
Workshop Facilitation
Word Processing
Practical Support
Desktop Publishing
Leadership skills
Media
Fundraising
Event Planning
Special Events Promotion
Translation/Interpreter Service
Other________________
Please turn-over
D – VOLUNTEER OPPORTUNITIES:
Please check your area(s) of interest. Indicate your preference by ordering them #1, 2, 3, etc.
Administration/Reception
Club/Bar/Bathhouse
General Outreach
Fundraising
Event/Planning
Support Department
Education/Prevention
Harm Reduction
Committee Work
Board of Directors
Immigration & Settlement
LGBT
E – AVAILABILITY:
Please mark below (√) the days/times you are available to volunteer
Time of Day
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
F – REFERENCES:
Please provide the name of personal or professional reference
Name _______________________________ Phone _____________________ Relationship______________
G – VOLUNTEER AGREEMENT:
At all times, the privacy and dignity of clients, donors, volunteers and staff will be respected, and the mission, vision and philosophy of
the Black Coalition for AIDS Prevention will be followed in accordance with the Black CAP’s policies, standards and guidelines. As a
volunteer of the Black Coalition for AIDS Prevention, you may have access to information and documents relating to clients, donors,
volunteers and staff that are private and confidential in nature. All volunteer and client records are the property of Black CAP and will be
treated as confidential material; reasonable care and caution should be exercised to protect and maintain total confidentiality. No
person shall read records or discuss such information unless there is legitimate purpose. Volunteer and client interactions shall not be
discussed with people outside Black CAP, including immediate family members, throughout and beyond tenure with Black CAP.
By signing below, you acknowledge that the information provided is true and accurate, and that you have read, understand,
and will abide by the agreement above. And, by signing below, you grant the Black Coalition for AIDS Prevention permission
to contact the references listed.
Signature ________________________ Date _____________________________________
Signature of Parents/Guardian (if under 18years old) __________________ Date ___________
OUR POLICY:
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national
origin, gender, sexual orientation, age or disability.
RETURN BY MAIL, FAX, EMAIL OR HAND TO:
Black Coalition for AIDS Prevention
20 Victoria Street, 4th Floor
Toronto, ON M5C 2N8
Fax: 416-977-7664
Email [email protected]
Thank you for completing this application form and your interest in volunteering with the Black
Coalition for AIDS Prevention.