Triad Health Project Volunteer Information Form and Confidentiality Statement
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PLEASE NOTE - WE ARE GRATEFUL TO HAVE MANY TERRIFIC VOLUNTEERS FOR ALL OF OUR ROUTINE ROLES WHO STICK WITH US FOR LONG PERIODS OF TIME. THIS ALSO MEANS THAT WE DO NOT OFTEN HAVE IMMEDIATE NEEDS FOR NEW VOLUNTEERS. PLEASE KNOW THAT IF WE DO NOT HAVE A CURRENT OPENING, WE WILL BE HAPPY TO KEEP YOUR INFORMATION ON FILE SHOULD ONE ARISE. THANK YOU FOR YOUR UNDERSTANDING AND PATIENCE. Thank you for your interest in volunteering with Triad Health Project! Volunteers play an essential role in helping THP effectively carry out its mission in this community. With the exception of HIV/STD testing on Monday nights and helping with special events, nearly all volunteer activities occur during our normal business hours, Monday-Friday from 8:30AM-5:00PM. Please help us maintain up-to-date information on our volunteers by completing the following form. This information must be collected before you can volunteer with THP.
Last Name
*
First Name
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Middle Initial
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Primary Telephone
*
Primary Phone Type
*
Home
Work
Mobile
Secondary Telephone
E-Mail Address
*
Best Method to Contact
*
E-Mail
Telephone
Either
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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Day
Please select a year
2024
2023
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1920
Year
Driver's License Number
*
Driver's License - Issuing State
*
Employer
*
Job Title
*
Students - School Name
Students - Class Year
Emergency Contact Person
*
Emergency Contact - Relation to Self
*
Emergency Contact - Phone Number
*
Most of THP's volunteer opportunities occur during business hours, M-Th from 8:30AM-5:00PM. On Mondays, we do utilize volunteers to help with HIV testing from 5:00-7:00PM in the Greensboro office. Special events sometimes necessitate the need for weekend volunteer support.
Availability - Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Availability - Times
*
Mornings
Afternoons
Evenings
Schedule Varies
Other Comments about Availability
Do you have access to your own personal vehicle?
*
YES
NO
Vehicle Type
*
Passenger Car
Van
SUV
Truck
I do not have a vehicle of my own
Areas of Volunteer Interest
*
Food Pantry - assist with stocking food pantry
Food Pickup - assist with picking up food from food banks and/or Ensure from Cone Hospital (trucks/SUVs ideal for this)
Grocery delivery to clients - Deliver food to clients weekly
Higher Ground - Providing and serving lunch to program participants, participating in and leading group activities, and transporting participants to the house and off-site programs
Client transportation - take clients to medical and social services appointments. Requires own vehicle,a valid NC Driver's License, proof of insurance, and must be at least 18 years of age
Special Events/Projects - help with Dining for Friends, Winter Walk for AIDS, bulk mailings, registration, special event logistics, holidays, and other events
General Office Support - helping with general tasks in the THP offices, including front-desk support and Monday night HIV/STI testing
Other - please indicate
Other Interests:
Additional Comments - Volunteer Interest
Special Needs / Limitations / Special Considerations as a Volunteer
Special degrees, courses, training, or experience that you have that will benefit your volunteer work with THP
Have you ever been convicted of a felony?
*
NO
YES
Confidentiality is paramount to THP and its clients. THP volunteers are responsible for maintaining the confidentiality of all proprietary information to which they are exposed to as a volunteer. Volunteers must treat any of the following information about THP clients as strictly confidential:
Name, HIV/STI status, sexual orientation, financial status, occupation, place of employment, home or work address, substance use issues, make or model of automobile, medical status or treatments
Confidentiality Attestation
*
I understand that as a THP volunteer, I must safeguard all confidential, proprietary, and privileged information to which I may be exposed. I also understand that my failure to maintain confidentiality may result in the termination of my volunteer duties and/or additional corrective actions.
I do not agree to these terms. I understand that I will not be allowed to volunteer with THP.
PLEASE NOTE: We often receive more volunteer requests than we can immediately fill. Please be patient with us. In the event we do not have an immediate opening, we will keep your form on file and contact you should an opening occur that is aligned with our needs and your interests and availability. Thank you!
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