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Tip It Forward Volunteers
Please fill this out for us to get to know you better. Thank you for your interest in Tip It Forward! We would love to have your help.
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Are you familiar with holistic medicine and whole health?
Your answer
What area are you most interested in? Please check all that apply.
*
Holistic Care Kit Making
Bus Wellness Clinic
Support Research and Evaluation
Interpreting
Promotion / Communication
Community Outreach
Other:
Required
What year were you born?
*
Your answer
What race do you identify as?
*
Black or African American
Asian or Asian American
American Indian or Alaska Native
White or European American
Native Hawaiian or other Pacific Islander
Latino, Latinx or Hispanic
Multi-racial
Write race(s) below if not listed
Your answer
Please write how you identify nationally / ethnically.
Your answer
What Gender(s) do you identify as?
*
Trans Female
Trans Male
Gender Queer
Female
Male
Non Binary
Write Gender Below, if not listed
Your answer
Do you work with a disability caused by such things as an accident or trauma, disease, or genetics that impacts your vision, hearing, speech, mobility, or mental function? Please check all that apply.
*
Vision
Hearing
Speech
Mobility
Mental Function
None of these apply to me
Required
What is your availability?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Mornings
Afternoons
Evenings
Other:
How many hours are you available?
2-3 hours per week
4 hours per week
8 hours per week
Once per month
Twice a month
Other:
Have you had training in any of these areas?
*
CPR and First Aid
Cultural Competency
History of Policies Rooted in Racial Prejudice
Compassionate Care
Meditation - Mindfulness / Awareness
Somatic based practice
Research or statistical analysis
Health screenings and Risk assessments
Health coaching
Other:
Required
What is your exposure and experience working across culture?
*
Your answer
What languages do you speak?
Your answer
Would you be interested in helping with community engagement, and event planning?
Yes
No
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