Johnson County Crisis Center

Volunteer -: Online Volunteer Form; Background Check Form pdf

Crisis Center Volunteer Application

Please fill out as much as this form as you can. We will get back to you as soon as possible. Thanks!

Contact Information

Name

Telephone Home

Telephone Work

Mailing Address

Present Address

City

State

Zip

Permanent Address
(if different than present)

City

State

Zip

General Information

Date of Birth (month / day)

How long do you plan to be in the area?

Occupation

Education

How did you hear about Crisis Center Training?

Do you know anyone at the Crisis Center?

Yes No

If so, who?

Are you usually in the area during summer and/or holidays?

Yes No

Questionaire

Explain why you would like to become a Crisis Center Volunteer:

What do you have to offer the Crisis Center?

What are your current activities or interests?

How would you describe yourself?

What circumstances are most likely to upset you?

What excites you about your life?

How does it feel to ask for help?

Who in our society should not recieve help?

Is there any additional information you would like to share with us?

Please list Two references:

Name:

Telephone:

Relationship to applicant:

Name:

Telephone:

Relationship to applicant:

Background Checks cost the Crisis Center $5 per applicant, although we do not require you to pay the fee, donations are accepted to cover the cost.

The Crisis Center employs and assists people without regard to age, sex, race, color, religion, creed, employment status, marital status, sexual orientation, national origin, disability, handicapped status, political affiliation, or associational preference. In no aspect of Crisis Center programs shall there be any difference in the treatement of persons bexause of race, creed, color, national origin, disability, age, gender, any consideration based on affectional sexual, or associational preference, or any classification which would deprive the person of consideration as an individual.

For immediate help:

(319) 351-0140
24 hours a day

Top 10 Suggested Donations to Food Bank

Canned Fruit
Canned Vegetables
Canned Meat
Canned Soup
Pasta
Jam or Jelly
Toilet Paper
Rice
Potato Products
Juice
More Information...

Special thanks to:

The UI Student Government supports the Crisis Center