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Volunteer Intake Practitioner Application
Thank you for your interest in volunteering at Insight Counseling Centers. Before you begin, please know that you will need to list two references at the end of this form. After you fill out and submit this online application, we will contact you about our available opportunities. If you have any questions, please contact Abbie Culbertson, Director of Marketing & Communications at
abbie@insightcenters.org
.
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Email
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Your email
Name
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Your answer
Phone Number
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Your answer
Street Address, City, State & ZIP Code
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Your answer
Date of Birth
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DD
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YYYY
How did you hear about Insight Counseling Centers?
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Your answer
Emergency Contact Information
Who should we contact in case of emergency?
Emergency Contact Name
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Your answer
Relationship
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Your answer
Phone Number
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Your answer
Connections to Supporters
Insight enjoys the support of several organizations and corporations in Middle Tennessee. Your connection to one of them might be of great help. (response optional)
If you currently work, where do you work?
Your answer
If applicable, what is your faith community?
Your answer
Previous Volunteer Experience
Have you volunteered before?
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Yes
No
If yes, where have you volunteered?
Your answer
What did you like best about your volunteer experience?
Your answer
Volunteering at Insight Counseling Centers
What inspires you to volunteer at Insight?
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Your answer
What special skills or talents do you possess that you would like to use as a volunteer?
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Your answer
Insight provides counseling sessions in both English and Spanish. For volunteers who are fluent in Spanish, there is an opportunity to assist Insight's Spanish-speaking clients at intake. Are you qualified and interested in this additional opportunity?
Yes
No
Clear selection
Select the days and times you are most likely to be available:
Morning
Afternoon
Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon
Monday
Tuesday
Wednesday
Thursday
Friday
Remote Volunteering Requirements
At this time, remote volunteering at Insight Counseling Centers requires access to a Windows PC, to which you have a password-protected user account, and a personal cell phone.
Do you have secure access to a computer (with an account only you have the password to) and a personal cell phone?
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Yes
No
Applicant Statement
I understand that Insight reserves the right to screen and select volunteers based on aptitude and needs, as well as to determine all volunteer placements and volunteer assignments. I affirm that the information I have provided is true and complete to the best of my knowledge. I understand that a background check, reference checks, and drug screening may be performed, and I give my permission for them.
Signature
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Your answer
Today's Date
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YYYY
References
1. Reference Name
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Your answer
Relationship
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
2. Reference Name
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Your answer
Relationship
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Your answer
Phone Number
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Your answer
Email Address
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Your answer
A copy of your responses will be emailed to the address you provided.
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