Volunteer Application

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.
* denotes required field
*Full Name:
*Home Address:		Check box if mailing address different
*City:
*State:		*Zip Code:
Phone:
*Cell Phone:		*Cell Carrier:
*Email:		Fax:
*Birth Date:
Employer:
*Occupation:
Special Skills/Training:
Requested Academy:
Types of Volunteer duties you are willing to assume (check all that apply)
Emergency Services Work Social Media Clerical Fundraising Other
If Other, please describe:
*Have you had previous volunteer experience?
If Yes, where?
Describe duties:
How did you hear about TIP?
*Do you have any allergies, physical limitations, or other health issues that are important for us to know?
If yes, please describe:
*Are you volunteering for school credit?
Why do you want to be a TIP volunteer?
*Have you experienced a traumatic incident in your life?
If so, when?
If yes, please explain:
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:		*Years known:
*Address (include City, State & Zip)
*Phone:		Email:
Reference 2
*Complete name:		*Years known:
*Address (include City, State & Zip)
*Phone:		Email:
Reference 3
*Complete name:		*Years known:
*Address (include City, State & Zip)
*Phone:		Email:
Emergency contacts: Please provide three people to contact in case of an emergency.
*Name:		*Relationship:
*Phone Number:

*Name:		*Relationship:
*Phone Number:

*Name:		*Relationship:
*Phone Number:

*Have you ever been convicted of a crime? No Yes
If yes, please explain and provide date, charge, and other pertinent details:
*Do you have any traffic violations in the last 10 years? No Yes
If yes, please explain:
California Law requires that motor vehicle owners be covered by automobile liability insurance. Please provide the following information:
*Insurance Carrier:		*Policy Number:
* I hereby affirm that the answers and statements provided in this application are true and correct.
* Please enter the characters exactly as they appear

Before submitting, please print and keep a copy of the application for your records.