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510-434-0307
5323 Foothill Blvd, Oakland, CA 94601
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HEPPAC
HIV Education & Prevention Project of Alameda County
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Organization
About us
Testimonials
Our Team
Our Team
Services
Syringe Access Program
Casa Segura Drop-In Center
Helpful & Working Harm Reduction Strategies
Community Outreach (Mobile Harm Reduction Services)
HIV & HCV Screening and Health Care Access
OPEND: Overdose Prevention and Education
Volunteer at HEPPAC
News
Contact
Donate
Home
Organization
About us
Testimonials
Our Team
Our Team
Services
Syringe Access Program
Casa Segura Drop-In Center
Helpful & Working Harm Reduction Strategies
Community Outreach (Mobile Harm Reduction Services)
HIV & HCV Screening and Health Care Access
OPEND: Overdose Prevention and Education
Volunteer at HEPPAC
News
Contact
Volunteer Application
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Volunteer Application
Volunteer Application
Volunteer Application
HIV Education Prevention Project of Alameda County Volunteer Application
Name
*
Address
City
Zip
Email
*
Home Phone
Cell Phone
*
May we contact your cell/work phone?
Yes
No
May we identify HEPPAC when leaving a message?
Yes
No
Are you over 18?
Yes
No
Are you a student?
Yes
No
Are you currently employeed?
Yes
No
If you are a student, name the educational institution and expected date of graduation:
If you are currently employed, your occupation:
Do you own or have access to a car with insurance?
Yes
No
What language do you speak?
*
Ethnicity (Optional)
What is your availability? Please check all times that apply
MON 10-4:00PM
TUE 10-4:00PM
TUE 5-8:00PM
WED 10-4:00PM
THU 10-4:00PM
THU 5-8:00PM
FRI 10-4:00PM
Are you available to volunteer on the occasional weekday evenings and/or weekends?
Yes
No
In case of emergency, whom should we contact?
*
*
Relationship to you:
How did you learn about volunteering at HEPPAC?
Have you volunteered before?
Yes
No
If "Yes", where?
If "Yes", please describe previous volunteer experience:
As a new HEPPAC volunteer, please describe your goals and expectations:
*
Briefly, describe how HIV/AIDS has effected your life:
Describe your experience with substance use treatment, with serious illness, death, and dying:
*
How do you feel about working with persons who may have altered physical appearances or physical/mental/emotional challenges resulting from illness, treatment, accident, or other causes?
*
Have you lived/worked with people of culture other than your own? Please explain.
*
Briefly, describe the sources of emotional support in your life?
Please rate your knowledge of HIV/AIDS:
*
excellent
fair
minimal
Please rate your knowledge of Harm Reduction:
*
excellent
fair
minimal
Skills you are willing to share with HEPPAC:
*
Accounting
Advertising/PR
Alternative Medicine
Artist
Attorney
Bookkeeping
Catering/Food Prep
Computer/IT
Customer Service
Data Entry
ESL/Translation
Education
Fundraising
Graphic Design
Health Education
Massage
Nurse/Doctor/Medical
Nutritionist
Outreach
Paralegal
Peer Advocacy
Photography
Research
Social Networking
Therapy/MFCC
Test Counselor - HIV
Video
Website Development
Writing
Other
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