test form - Simpson Housing

Basic Information

Name*

First Last

Preferred Name

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Birth Date*

Gender

Simpson Housing Services celebrates and embraces the uniqueness and dignity of every person. As a community institution, we are committed to organizational practices that affirm and respect how people describe, express, and experience their gender and sexuality, including trans, nonbinary, and genderfluid identities. We invite prospective volunteers to share their preferred names and pronouns and our staff commit to honoring these identities and expressions.

Gender Pronouns

Ethnicity & Race

Simpson Housing Services celebrates and embraces the uniqueness and dignity of every person and we model inclusive organizational structure and practices. As a community institution, we support diverse communities and offer programming and services that further racial and ethnic justice. We are committed to sustaining a diverse group of volunteers and, as an option, you may share your ethnicity and race.

Hidden

As of June 2021, it is the policy of Simpson Housing Services to require all volunteers working directly with program participants to be fully vaccinated against COVID-19. Are you fully vaccinated against COVID-19?*

A person is fully vaccinated 2 weeks after their second dose in a 2-dose series, such as the Pfizer or Moderna vaccines, or 2 weeks after a single-dose vaccine, such as Johnson & Johnson's Janssen vaccine.

Emergency Contact Information

Name*

First Last

Relationship to You*

Emergency Contact Phone Number*

Simpson Housing Services Values

Volunteers are important to our mission to house, support, and advocate for people experiencing homelessness.

Our promise to volunteers is to do the very best we can to make your experience meaningful and impactful. We respect the skills, dignity, and individual needs of each volunteer, as well as provide supportive supervision and constructive feedback on performance.

We are committed to providing ongoing education opportunities for volunteers to learn about homelessness, affordable housing, racial equity, and other topics related to our work.

Lastly, we pledge to treat our volunteers as integral and essential members of our team. We ask that our volunteers do their part in upholding the values of Simpson Housing. By applying to volunteer, you are agreeing to the following values:

We believe that everybody has the right to safe and affordable housing
We celebrate and embrace the uniqueness and dignity of every person.
We encourage people to draw upon their strengths and promote the power of self-advocacy.
We advocate against the injustices of society that cause homelessness and poverty.
We strive to create a collaborative community with the individuals we serve, within Simpson, and with the greater community

Simpson Housing Services Values Agreement*

Yes, I agree to uphold the values of Simpson Housing.
No, I do not agree to uphold the values of Simpson Housing.
I need more information about Simpson Housing’s values.

What questions or comments do you have about our values?

Volunteer Position Interest

Volunteer Position Interest*

Questions Specific to Literacy Mentors

Why are you hoping to mentor a young person with Simpson Housing Services?*

Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

What are your hobbies and interests?*

What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

Can you commit to the Simpson Literacy Mentor Program for 10 months, being in contact with your mentee for weekly literacy lessons and monthly enrichment outings?*

Yes
No

Do you forsee any issues meeting the above requirement (ex: possible relocation, unreliable transportation, major life changes, etc.)

Please describe any personal vacation plans that may interfere with your ability to be a consistent volunteer for a student.

Do you have any medical or health-related concerns which could affect your ability to perform those activities expected of you as a mentor or ensure the safety of the student in your care, especially in the event of an emergency? If so, please explain.

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from their last service date with Simpson Housing Services.

Have you ever been refused participation in any other youth program? If yes, please explain.*

Do you have a current driver’s license and reliable vehicle?*

Yes
No

Have you had any driving citations and/or moving violations in the past 5 years? If yes, please explain.*

Have you ever been convicted of a crime? If yes, please explain.*

Have you ever been investigated or convicted of child abuse or neglect, or of sexually abusing a youth 18 years or younger? If yes, please explain.*

About You

Why do you wish to volunteer with Simpson Housing Services?*

Briefly describe previous volunteer experiences (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

Share your educational background, training, language skills, etc.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

What are your hobbies and interests?*

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from the exit date.

Position Interest*

Please indicate the volunteer position(s) you are interested in:

Shelter Evening Meal
Shelter Breakfast Meal
Youth Group Overnight Stay and Breakfast Meal
Family Housing Evening Meal
Special Event Meal

About your Group

Who is your group comprised of? (Faith community, corporation, civic organization, school, family/friends, other?)*

What is the name of your group?*

Does anyone in your group have experience cooking for a large group?*

Yes
No

What would your group like to get out of this volunteer experience?*

By submitting your application, you agree to the following:

I certify that my answers are true and complete and I understand that if they are not, I am disqualifying myself for a volunteer position.
I also understand that I am applying for a volunteer position and that this is not an application for, or a contact of, employment.
I understand that this application does not guarantee a placement, and that either Simpson or myself can terminate the process of applying at any point without an explanation.
I authorize the above references to give Simpson Housing Services any pertinent information they may have and authorize investigation of all statements contained in this application.

Were you approached by a young person in this program to serve as their mentor? If yes, who is the young person and how do you know them?*

Why do you want to become a mentor with Simpson Housing Services?*

How did you hear about us? Please be as specific as possible.*

Do you have any previous experience volunteering or working with youth? If so, please describe (including name of organization, time of involvement, type of work).*

Have you ever been refused participation in any other youth program? If yes, please explain.*

What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

Share your educational background, training, language skills, etc.*

What language(s) are you proficient in?*

What is your occupation (current or previous)?*

Can you commit to the Simpson Mentoring Program for nine months, being in contact with your mentee weekly, and seeing them a minimum of 20 weeks out of the year?*

Yes
No

Do you foresee any issues meeting this time requirement (ex. planned extended vacations, possible relocation, unreliable transportation, etc.)?*

Do you have any medical or health-related concerns which could affect your ability to perform activities expected of you as a mentor or ensure the safety of the student in your care, especially in the event of an emergency? If so, please explain.*

Have you had any driving citations and/or moving violations in the past 5 years? If yes, please explain.*

Have you ever been convicted of a crime? If yes, please disclose all convictions in the last 10 years, including the year and state of conviction. Having a conviction doesn't necessarily exclude you from volunteering.*

Have you ever been investigated or convicted of child abuse or neglect, or of sexually abusing a youth 18 years or younger? If yes, please explain.*

Why are you hoping to mentor a young person with Simpson Housing Services?*

Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

What are your hobbies and interests?*

What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.*

What language(s) are you proficient in?*

Employer*

What is your occupation (current or previous)?*

Can you commit to the Simpson Middle School Mentor Program for 12 months, being in contact with your mentee for weekly, and seeing them a minimum of 3 weeks out of each month?

Yes
No

Do you forsee any issues meeting the above requirement (ex: possible relocation, unreliable transportation, major life changes, etc.)

Please describe any personal vacation plans that may interfere with your ability to be a consistent volunteer for a student.

Do you have any medical or health-related concerns which could affect your ability to perform those activities expected of you as a mentor or ensure the safety of the student in your care, especially in the event of an emergency? If so, please explain.

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from their last service date with Simpson Housing Services.

Have you ever been refused participation in any other youth program? If yes, please explain.

Do you have a current driver’s license and reliable vehicle?

Yes
No

Have you ever been convicted of a crime? If yes, please explain.*

Have you ever been investigated or convicted of child abuse or neglect, or of sexually abusing a youth 18 years or younger? If yes, please explain.*

Why are you hoping to tutor a young person with Simpson Housing Services?*

Briefly describe your experience working or volunteering with youth (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

What are your hobbies and interests?*

What qualities, skills, training, or other attributes do you feel you have that would benefit a youth? Please explain.*

Do you have a license in education?

Yes, I have a current license
Not now, but I had a license in the past.
No

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

Can you commit to the Simpson Tutoring Program for the school year, participating in weekly tutoring sessions?

Yes
No

Do you forsee any issues meeting the above requirement (ex: possible relocation, unreliable transportation, unpredictable work schedule, major life changes, etc.)

Please describe any personal vacation plans that may interfere with your ability to be a consistent volunteer for a student.

Occasionally we are unable to place tutors because we have limited space, or a tutor’s schedule doesn’t allow for a weekly commitment. In the event that we cannot place you for weekly tutoring, would you be interested in being a substitute tutor? Substitute tutors are contacted when regular tutors are on vacation.

Yes
No

Students participating in the tutoring program are invited to attend monthly enrichment outings. Outings are typically on Saturday mornings and we need a few volunteers to assist with each outing. Is this something you would be interested in helping with?

Yes
No

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from their last service date with Simpson Housing Services.

Have you ever been refused participation in any other youth program? If yes, please explain.

Have you ever been convicted of a crime? If yes, please explain.*

About You

Why do you wish to volunteer at Adult Shelter Connect?*

Briefly describe previous volunteer experiences (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

Share your educational background, training, language skills, etc.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

What are your hobbies and interests?*

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from the exit date.

Have you ever been convicted of a crime? Please disclose all convictions in the last 10 years, including the year and state of conviction. Some of our positions involve confidential information and contact with vulnerable populations. Having a conviction doesn’t necessarily exclude you from volunteering.*

Are you currently attending school?*

Yes
No

Will you receive academic credit for your volunteer work?*

Yes
No

School Name*

Course Name*

Required Number of Hours*

Due Date*

Are you volunteering because of a court order?*

Yes
No

Jurisdiction Information*

Required Number of Hours*

Due Date*

About You

Why do you wish to volunteer in an emergency shelter?*

Briefly describe previous volunteer experiences (name of organization, time of involvement, type of work):*

Have you had any experience working with people in poverty or people experiencing homelessness? Please describe experience if applicable.*

Please describe your experience working with people from a variety of cultural backgrounds.*

Share your educational background, training, language skills, etc.*

What language(s) are you proficient in?*

Employer

What is your occupation (current or previous)?*

What are your hobbies and interests?*

Have you utilized our services (Shelter, Transitional Housing, etc.) in the past?*

Individuals who have utilized our services are welcome to volunteer when stably housed for two years from the exit date.

Have you ever been convicted of a crime? Please disclose all convictions in the last 10 years, including the year and state of conviction. Some of our positions involve confidential information and contact with vulnerable populations. Having a conviction doesn’t necessarily exclude you from volunteering.*

Are you currently attending school?*

Yes
No

Will you receive academic credit for your volunteer work?*

Yes
No

School Name*

Course Name*

Required Number of Hours*

Due Date*

Are you volunteering because of a court order?*

Yes
No

Jurisdiction Information*

Required Number of Hours*

Due Date*

What would you like to get out of a volunteer experience?

Are you looking for a volunteer opportunity for yourself or for a group?

When are you typically available to volunteer?

Are you looking for something you can do from home, or are you looking for a direct service opportunity?

Would you prefer volunteering with children, adults, or both?

Are you currently attending school?*

Yes
No

Will you receive academic credit for your volunteer work?*

Yes
No

School Name*

Course Name*

Required Number of Hours*

Due Date*

Are you volunteering because of a court order?*

Yes
No

Jurisdiction Information*

Required Number of Hours*

Due Date*

Thank you for your interest!

Additional Information: References

Please list three persons, not related to you, who would have knowledge of your qualifications to volunteer. One of the references must be professional; such as a current or former employer, colleague, teacher, etc.

Name*

Full Name Phone Email Address Relationship

Name*

Full Name Phone Email Address Relationship

Name*

Full Name Phone Email Address Relationship

By submitting your application, you agree to the following:

I certify that my answers are true and complete and I understand that if they are not, I am disqualifying myself for a volunteer position.
I also understand that I am applying for a volunteer position and that this is not an application for, or a contact of, employment.
I understand that this application does not guarantee a placement, and that either Simpson or myself can terminate the process of applying at any point without an explanation.
I authorize the above references to give Simpson Housing Services any pertinent information they may have and authorize investigation of all statements contained in this application.

Initials

Name

This field is for validation purposes and should be left unchanged.