Name

Address

City  Zip

Home phone Work phone

Email

1. Are you a UW-Madison student?

Yes No

2. How did you hear about volunteering at The Rape Crisis Center?

3. Please select one volunteer oppurtunity for which you would like to train at this time:

Crisis Line Counselor

Special Projects Volunteer

4. Why are you interested in volunteering at The Rape Crisis Center?

5. Do you have any paid or volunteer experiences, education or life experiences that may apply to your volunteer work at the Rape Crisis Center? Please describe.

6. Have you ever been a client of the The Rape Crisis Center?

Yes No

If yes, when?

7. Will you be available to volunteer during June, July, and August? Yes No

8. The Rape Crisis Center has adopted an Affirmative Action Policy in compliance with Federal Law. In an attempt to judge the effectiveness of our recruitment efforts, we request the following information. This information will not be used, in any way, regarding decisions to become or continue to volunteer at the Rape Crisis Center.

Sex: Male Female

Veteran Status:

Race: