Intern/Volunteer Application

Intern/Volunteer Application

Thank you for your interest in Mental Health Association in Orange County, Inc. (MHA). MHA is a non-profit agency that seeks to promote the positive mental health and emotional well-being of Orange County residents, working towards reducing the stigma of mental illness, developmental disabilities, and providing support to victims of sexual assault.

Volunteering is a very rewarding experience. If you are looking to be part of a nationally recognized organization with a highly regarded reputation in the Orange County community, then you have chosen the right place!

Not only does volunteering assist those in need, it’s also a way to receive valuable experience as well as current and relevant training in the human services field. Volunteering is a good way to meet other like-minded individuals and have access to possible career opportunities within MHA.

All interested volunteers must fill out an application and complete the reference form, providing 3 references. Also, please be aware that any volunteer/interns may be asked to complete a background check and fingerprinting clearance.

Name Name First Last
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Mental Health Association in Orange County, Inc. is committed to a policy of equal opportunity and will not discriminate against an applicant based on their age, sex, pregnancy, sexual orientation, race, color, creed, religion, national origin or ancestry, citizenship, marital status, disability, victim of domestic violence, military or veteran status or any other category protected under federal, state or local law, regulation or ordinance.
Are you now, or have you ever been registered in a Child Abuse Registry Clearinghouse for New York or any other state?

The names of applicants who will have the potential for regular and substantial contact with children will be submitted to the NYS Central Register for Child Abuse and Maltreatment to determine if applicant is the subject of an indicated report of child abuse or maltreatment.

Are you now, or have you ever been registered in a Child Abuse Registry Clearinghouse for New York or any other state?

The names of applicants who will have the potential for regular and substantial contact with children will be submitted to the NYS Central Register for Child Abuse and Maltreatment to determine if applicant is the subject of an indicated report of child abuse or maltreatment. Yes No

What times and days are you available?
What times and days are you available?	Monday	Tuesday	Wednesday	Thursday	Friday	Weekends
Morning	MorningMonday	MorningTuesday	MorningWednesday	MorningThursday	MorningFriday	MorningWeekends
Afternoon	AfternoonMonday	AfternoonTuesday	AfternoonWednesday	AfternoonThursday	AfternoonFriday	AfternoonWeekends
Evening	EveningMonday	EveningTuesday	EveningWednesday	EveningThursday	EveningFriday	EveningWeekends

What programs are you interested in volunteering/interning for?

What programs are you interested in volunteering/interning for? Administration Compeer Orange County Crisis Call Center Rape Crisis Vet2Vet Hudson House Care Coordination Invisible Children's Project Home-to-Stay Developmental Disability Family Support (CAPIS, BLUE REN, ASSIST etc.) Community Engagement
Do you have any prior or current experience in direct care work relevant to the program(s)
you are interested in?

Do you have any prior or current experience in direct care work relevant to the program(s)
you are interested in? Yes No
If yes, please describe your experience:
Please describe any specialized education or training, if any:
What Languages do you speak? read? write?
Please describe any current/relevant activities, interests, hobbies or volunteer experiences:
Resume or CV

Attach Files
References

Please list 3 references. Ensure that at least one of them was a supervisor or either a volunteer or paid position that you held. The other two can be peers or colleagues.
Reference #1 - Name Reference #1 - Name First Last
Reference #1 - Company & Title Reference #1 - Company & Title First Last
Reference #1 - Phone Reference #1 - Phone - ### - ### ####
Reference #1 - Email
Reference #1 - In what capacity do you know this person?
Reference #1 - Length of Acquaintance
Reference #2 - Name Reference #2 - Name First Last
Reference #2 - Company & Title Reference #2 - Company & Title First Last
Reference #2 - Phone Reference #2 - Phone - ### - ### ####
Reference #2 - Email
Reference #2 - In what capacity do you know this person?
Reference #2 - Length of Acquaintance
Reference #3 - Name Reference #3 - Name First Last
Reference #3 - Company & Title Reference #3 - Company & Title First Last
Reference #3 - Phone Reference #3 - Phone - ### - ### ####
Reference #3 - Email
Reference #3 - In what capacity do you know this person?
Reference #3 - Length of Acquaintance