Volunteer - Gathering Hope House

Full Name*

E-mail*

Phone Number*

Where did you hear about Gathering Hope House and our volunteer opportunities?*

Times Available

Mornings
Afternoons
Evenings

Have you been convicted of a felony within the past five years?

No
Yes

Do you have any prior experience (personal, volunteer, or professional) with mental health or alcohol and other drug (AOD) services?

No
Yes

Describe Prior Experience Below:

Emergency Contact (Name, Phone Number, Relation)*

If you have a disability, what accommodations would you need to do this volunteer position?

Confidentiality and Privacy Agreement

Confidentiality and Privacy Agreement
Gathering Hope House volunteers are entrusted with sensitive and personal information about members. All volunteers are expected to uphold strict confidentiality at all times. This includes compliance with federal privacy regulations (HIPAA) and organizational policies. Any disclosure of member information outside of approved staff or program purposes is strictly prohibited and may result in termination of volunteer status, as well as potential legal consequences.

Do you understand and agree to abide by these confidentiality and HIPAA requirements?

Yes
No