Volunteer Application

* Required
Title
First Name *	Last Name *
Email Address *
Gender* Male Female	Date of Birth *
Street *	Suburb *
State *	Postcode *
Phone - BH *	Phone - AH *
Please list current occupation/studies*
How did you hear about the Mind Volunteering Program? *
Why do you want to be a Mind Volunteer? *
Have you had any exposure or experience with somebody who has a mental illness? *
What are your interests, skills and hobbies? *
Do you have any special interests or skills you could offer the program as a volunteer? *
Is there any further personal information that may impact your role as a Volunteer? *
What is your nationality? *
What languages do you speak? *
Do you have a preference of locality? *
Do you have a driver’s license *	Yes No
Do you have access to a car? *	Yes No
Do you have access to public transport? *	Yes No
Can you commit to being a Volunteer for at least 12 months?*	Yes No
Can you commit to 2 hrs per fortnight? *	Yes No
What is the best time to contact you *
Please provide name, address and telephone numbers of two referees (Must have at least one professional referee example: Employer, Manager, Priest, Teacher, Tutor etc):
Referee #1 *	Referee #2 *
Please provide the contact information of an Emergency Contact:
Name *	Relationship *
Phone *	Address *
Enter Word Verification in box below *
By submitting this application form and on being accepted as a Mind Volunteer, I understand that attending training sessions is a compulsory component of my commitment to the program, and I will remain involved with the Mind Volunteer Program for a 12 month minimum.•* I agree

Privacy of your personal information

The information that you provide to us is used by Mind to facilitate the volunteer placement process within our organisation. If you do not wish to provide the requested information, we may not be able to induct you as a volunteer.

Your information will be held confidential and secure, and will not be disclosed to any other party without your consent. It may be disclosed to relevant departments within Mind for Volunteer placement purposes and statistical data only. You may gain access to the information we collect from you by following the guidelines in “you guide” booklet in your information pack.