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510-434-03075323 Foothill Blvd, Oakland, CA 94601

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HEPPAC

HIV Education & Prevention Project of Alameda County

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Join Our Team
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Contact

Volunteer Application

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Volunteer Application

HIV Education Prevention Project of Alameda County Volunteer Application

Name *

Address

City

Zip

Email *

Home Phone

Cell Phone *

May we contact your cell/work phone?

Yes

No

May we identify HEPPAC when leaving a message?

Yes

No

Are you over 18?

Yes

No

Are you a student?

Yes

No

Are you currently employeed?

Yes

No

If you are a student, name the educational institution and expected date of graduation:

If you are currently employed, your occupation:

Do you own or have access to a car with insurance?

Yes

No

What language do you speak? *

Ethnicity (Optional)

What is your availability? Please check all times that apply

MON 10-4:00PM

TUE 10-4:00PM

TUE 5-8:00PM

WED 10-4:00PM

THU 10-4:00PM

THU 5-8:00PM

FRI 10-4:00PM

Are you available to volunteer on the occasional weekday evenings and/or weekends?

Yes

No

In case of emergency, whom should we contact? *

*

Relationship to you:

How did you learn about volunteering at HEPPAC?

Have you volunteered before?

Yes

No

If "Yes", where?

If "Yes", please describe previous volunteer experience:

As a new HEPPAC volunteer, please describe your goals and expectations: *

Briefly, describe how HIV/AIDS has effected your life:

Describe your experience with substance use treatment, with serious illness, death, and dying: *

How do you feel about working with persons who may have altered physical appearances or physical/mental/emotional challenges resulting from illness, treatment, accident, or other causes? *

Have you lived/worked with people of culture other than your own? Please explain. *

Briefly, describe the sources of emotional support in your life?

Please rate your knowledge of HIV/AIDS: *

excellent

fair

minimal

Please rate your knowledge of Harm Reduction: *

excellent

fair

minimal

Skills you are willing to share with HEPPAC: *

Accounting

Advertising/PR

Alternative Medicine

Artist

Attorney

Bookkeeping

Catering/Food Prep

Computer/IT

Customer Service

Data Entry

ESL/Translation

Education

Fundraising

Graphic Design

Health Education

Massage

Nurse/Doctor/Medical

Nutritionist

Outreach

Paralegal

Peer Advocacy

Photography

Research

Social Networking

Therapy/MFCC

Test Counselor - HIV

Video

Website Development

Writing

Other

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