Join Our Team Become part of a remarkable team making a difference in our community! Volunteer Application Name* First Last Phone*Email* May we share your e-mail for Lydia Place communications only?*YesNoAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Program Interest Wise Buys Transitional House / Admin (Floater) Children’s Program Resident Groups Donation Coordinator Special Events Hobbies / InterestsList any hobbies or skills you would like to offer as a volunteer.EducationLast School AttendedDatesMajor / DegreeAre you using this volunteer opportunity to satisfy any work / school / legal requirements?*YesNoIf yes, please explain:*Work and Volunteer ExperienceList Position, Dates Employed, and Duties / ActivitiesPlease leave a blank line in between each position listed.ReferencesList Name, Address / Phone Number, and your Relationship. Do not include family members as references. Please leave a blank line in between each reference listed.Agreements and SignatureConfidentiality Agreement As a condition of volunteering at Lydia Place, I agree not to divulge any information concerning our clients. I recognize that unauthorized release of information may subject me to civil liability, under provision of state law. The information in this form is accurate. I understand that my application will be kept confidential and will be used to check my references.Confidentiality Agreement Acknowledgement* Yes, I have read and agree to the Confidentiality Agreement. Safe Space Agreement I will abide by the guidelines listed below during my time at the Lydia Place Transitional House: No violence. No racist, homophobic, sexist, ageist, classist, or otherwise discriminatory or derogatory comments (verbal or written) directed at anyone at the Transitional House. Everyone is expected to respect each other’s differences in race, ethnicity, physical ability, mental health, size gender, gender identity and sexuality. Bullying will not be tolerated. Intoxicated individuals are not welcome at the Transitional House. Please respect all staff. They are here to help you and create a positive experience for you. Please refrain from using foul or offensive language. Sexual Harassment will not be tolerated. In the same way that Lydia Place is a safe place for me to be, I understand that I must also help to preserve a safe environment by follow the guidelines listed above and by using my best judgment to make decisions that will affect other people. Safe Space Agreement Acknowledgement* Yes, I have read and agree to the Safe Space Agreement. Signature*Directions: Use your mouse cursor or finger / stylus (if on a touch enabled device) to sign your name. By signing and submitting this form you are agreeing to adhere to and abide by the stipulations outlined in both the Confidentiality Agreement as well as the Safe Space Agreement, and are confirming that the information you have listed on this form is accurate to the best of your knowledge.