To submit your Volunteer Application, complete and submit this form. Upon submission, you will be directed to a confirmation page where you can submit the $60 Registration Fee with PayPal. If you prefer, you can mail the registration fee to Trauma Intervention Programs, 4140 Oceanside Blvd., Suite 159-321 , Oceanside, CA 92056. Please contact us if you have any questions.
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* denotes required field |
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*Full Name: |
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*Home Address: |
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Check box if mailing address different |
*City: |
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*State: |
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*Zip Code: |
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Phone: |
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*Cell Phone: |
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*Cell Carrier: |
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*Email: |
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Fax: |
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*Birth Date: |
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Employer: |
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*Occupation: |
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Special Skills/Training: |
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Requested Academy: |
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Types of Volunteer duties you are willing to assume (check all that apply) |
Emergency Services Work
Social Media
Clerical
Fundraising
Other
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If Other, please describe: |
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*Have you had previous volunteer experience? |
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If Yes, where? |
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Describe duties: |
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How did you hear about TIP? |
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*Do you have any allergies, physical limitations, or other health issues that are important for us to know? |
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If yes, please describe: |
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*Are you volunteering for school credit? |
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Why do you want to
be a TIP volunteer? |
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*Have you experienced a traumatic incident in your life? |
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If so, when? |
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If yes, please explain: |
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References: Give three references, not related by blood or marriage, who are responsible adults of reputable standing in their community, all of whom you have known you for at least 3 years. |
Reference 1 |
*Complete name: |
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*Years known: |
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*Address
(include City, State & Zip) |
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*Phone: |
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Email:
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Reference 2 |
*Complete name: |
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*Years known: |
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*Address
(include City, State & Zip) |
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*Phone: |
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Email:
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Reference 3 |
*Complete name: |
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*Years known: |
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*Address
(include City, State & Zip) |
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*Phone: |
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Email:
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Emergency contacts: Please provide three people to contact in case of an emergency. |
*Name: |
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*Relationship: |
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*Phone Number: |
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*Name: |
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*Relationship: |
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*Phone Number: |
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*Name: |
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*Relationship: |
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*Phone Number: |
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*Have you ever been convicted of a crime?
No
Yes
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If yes, please explain and provide date, charge, and other pertinent details: |
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*Do you have any traffic violations in the last 10 years?
No
Yes
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If yes, please explain: |
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California Law requires that motor vehicle owners be covered by automobile liability insurance. Please provide the following information: |
*Insurance Carrier: |
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*Policy Number: |
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I hereby affirm that the answers and statements provided in this application are true and correct. |
* Please enter the characters exactly as they appear
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Before submitting, please print and keep a copy of the application for your records. |
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