24 Hour Toll Free Crisis Line: 800-411-1333

Please use the form below to apply to volunteer online.

You may also download a printable version of the form in either MS Word or Adobe PDF Format.

Completed forms may be mailed to:
Faith House
Attn: Jackie Chiasson
P.O.Box 93145
Lafayette, Louisiana 70509

FIELDS MARKED WITH * ARE REQUIRED!

Name:*

(First)

(MI)

(Last)

Address:*

City:*

State:*

Zip:*

Date of Birth:

/ /

E-Mail Address:*

Employer:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Phone:

(########## all 10 digits without () or -)

Home:*

Work:

Other:

Religious/Civic/Professional Affiliations:

Where did you hear about our volunteer program?

Are you in school?

Yes No

If "yes" Where?

Educational Degrees / Training:

Would you have a problem being fingerprinted?

Yes No

Do you have any limitations that would preclude you from performing any work for which you are being considered?

Yes No

If yes, Please explain:

Why would you like to volunteer for Faith House?

Have you ever volunteered at another agency?

Yes No

If yes, where and what were your duties?

What days and times are you available to volunteer?

How many hours a week can you commit?

Do you personally know someone who, has been or is currently a victim of Domestic Violence?

Yes No

If no, do you have any knowledge about victims of domestic violence?

If you have ever been a victim of abuse, you may encounter a resident who has had an experience similar to your own. Realize this may bring back memories of your abuse

List three references (not family members). At least one should be a professional reference such as an employer, clergy person, etc. Reference letters will be sent; therefore we ask that you supply ALL information. (Be sure to include all numbers, street, apt, zip, etc.)

Reference One:

Name:

Phone:

Street Address:

City/State/Zip:

Relationship:

Reference Two:

Name:

Phone:

Street Address:

City/State/Zip:

Relationship: