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Help, Hope & Healing
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Addiction Treatment Staff
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Friend or Family Member
Admission Info
Treatment Programs
Mother and Child Residential Program
Programs For Pregnant Mothers
Rehab For Women
Residential Rehab
Addiction Therapy Services
Adult Programs
Children’s Programs
Alcoholism Treatment Program
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About Susan B Anthony Recovery Center
Addiction Treatment Staff
Mother and Child Residential Program
Programs For Pregnant Mothers
Rehab For Women – Helping a Friend or Family Member
Addiction Treatment Admissions
Addiction Treatment Programs and Services
Donate to Susan B Anthony Recovery Center
Contact Susan B Anthony Recovery Center
VOLUNTEER APPLICATION
ADULT
STUDENT
INTERN
SUBSIDIZED
VOLUNTEER
Name
Date Of Birth
Date
Address
Zip
Home
Cell
In case of emergency
contact person:
Are You:
Employed
Full-Time
Full-Time Student
Retired
Not Working at this time
If employed, by whom?
Title or position:
May we contact you at work?
Yes
No
Leave a message
Work phone & extension:
Have you ever been convicted of a Felony?
Yes
No
(Please Explain).
You must complete this section to be considered for a position. Convictions are evaluated for each position
and not necessarily disqualifying.
Date & Location of Conviction:
Penal Code#
Explanation
Education
Middle School
High School
Some College
BS
Graduate
Ph.D.
Friend/Family
Volunteer Match
Media/Newspaper/TV
Work/School/Church
Volunteer Broward
Internet
United Way
Other
How did you hear about volunteering with SBA?
Are you volunteering for community services hours?
Civil
Federal
Telephone#
Supervisor / Officer
What is the time frame for completing
your community hours?
Minimum hours per week/month:
Official papers on file:
Please identify your interest and skills you will bring to SBA by checking all that apply:
Knowledge of graphics, advertising and promotional materials
Adult literacy
Craft activities
Data collection, record keeping, statistics
Working with Adults with young children
Child care
Reading and storytelling
Fund-raising activities (over the age of 18)
Mentoring moms
Donation pick-ups
General clerical or administrative
Building maintenance (gardening, painting)
Participating in group activities with clients
Special events
Other
Volunteer Availability
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
Afternoon
Evening
Please submit information of two (2) references
Reference Name #1
Phone
Address
City
Zip Code
Reference Name #2
Phone
Address
City
Zip Code
Briefly: Describe your interest in volunteering for the Susan B. Anthony Recovery Center
STUDENTS: If under 18 years of age, please list name of Parent/Guardian responsible for you:
(Parent/Guardian must give their consent before you can volunteer. List their Daytime and Cell phone number where we can contact them to verify consent.)
Parent / Guardian
Phone
I hereby give permission for my son/daughter to volunteer at Susan B. Anthony Recovery Center:
Parent / Guardian Signature
Date
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Home
About
Addiction Treatment Staff
Are You a Mom?
Are You Pregnant?
Friend or Family Member
Admission Info
Treatment Programs
Mother and Child Residential Program
Programs For Pregnant Mothers
Rehab For Women
Residential Rehab
Addiction Therapy Services
Adult Programs
Children’s Programs
Alcoholism Treatment Program
Educational and Vocational Services
Donate
Contact
.