First Name (required)

Last Name (required)

Date of Birth (required)

Gender (required) Male Female Non-conforming Transgender

Preferred Pronouns: (required)

Ethnicity (required) African American Alaskan Native American Indian Asian Black Hispanic Latino/x Multi-Racial Native Hawaiian White

Primary Language English Spanish Both English and Spanish Cantonese Vietnamese Korean Other Prefer not to answer Unknown

Other Language

Address (required)

City (required)

State (required)

Zip (required)

County (required) Carson City El Dorado Nevada Placer Washoe Other

County - Other:

Email (required)

Cell Phone

Password (required)

Volunteer Information

Can you speak, read, or write a language other than English? Yes No

List any skills, hobbies, or interest that might be useful in this work.

Personal or professional experience with sexual assault, domestic abuse or child abuse? Yes No

Willing to share personal experience in public forum? Yes No

Why are you interested in becoming a volunteer?

Background Verification

Have you ever been convicted of a felony? Yes No

Have you ever been convicted of neglect, abuse, or assault? Yes No

Has your driver's license ever been suspended or revoked in any state? Yes No

Professional Skills

Media/Photo Waiver Agree Disagree

Accounting

Marketing

Editing

Stagecraft

HTML/web hosting

Digital Security

Volunteer Interest

Handyman

Legal

Graphics/typesetting

Fitness instruction

Hunger relief

Helpline

Children (Vol Interest)

Safehouse

Prevention

Empowerment Groups

Legal Advocacy