North Jersey Practical Support Volunteer Inquiries
Thank you for expressing interest in driving patients to abortion clinics in North Jersey! The first step is to fill out this form. A volunteer will then follow up with you about next steps.
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Full Name *
Preferred Name (ex. nickname)
Pronouns
Mobile Phone Number *
Email Address *
Municipality of Residence *
I have had a driver's license for more than 5 years. *
Required
Clinic Locations I will Drive to: *
Required
General Availability (with adequate notice) *
Required
My license, car registration, and car insurance are all current, and I understand that I will need to provide proof that these documents are current. *
Required
It is expected that I will have my car inspected by the deadline indicated on the sticker on my car windshield. *
Required
I understand that training is required, including anti-bias training. *
Required
I agree to serve patients regardless of their religion, race, gender, sexuality, disability, or other protected category, to treat them with respect, and to treat their personal information and stories with confidentiality. *
Required
I understand that additional vetting of volunteer applicants is required to keep patients safe, and a volunteer will contact me about next steps. *
Required
How did you hear about us? *
Questions or Comments
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