Volunteer Signup

Thank you for you interest in volunteering for Planned Parenthood of Kansas & Mid-Missouri. The information you provide on this form will help us determine the most satisfying volunteer opportunity for you within Planned Parenthood. Please complete all sections.

Today’s Date: Tuesday, October 01, 2013

 

Contact Information
First:
Middle:
Last:
StreetAddress:
City:
State:
Zip:
Phone(Day):
Evening:
Cell:
Best way to contact you?
Day Evening Cell Email
Email Address
Are you under the age of 18?
Yes No (Applicants under the age of 18 must obtain parental consent to volunteer.)
Would you like to be placed on the Planned Parenthood Action Network e-mail list? Yes No
Male Female(optional)
Have you ever volunteered with PPKM before?
Yes No

Volunteer Interests - Plead read through our Volunteer Opportunities and mark which positions most interest you.
Some positions may require interviews and/or background checks.

Event Volunteer

-Assist in day-of-event activities
-Become an event committee member
-Assist in planning and organizing events

 Administrative Volunteer

-Prepare supporter mailings
-Provide general clerical support
-Assist with special projects

 Advocacy & Outreach Volunteer

-Join a Reproductive Health Action Team in Kansas or Missouri
-Participate in visibility events, rallies & tabling events
-Assist organizers in phone banking, data entry & special advocacy projects
Education Member

-Advocate for education & health center services at community events
-Co-facilitate sex-education workshops
-Help with classroom preparation & instruction

Health Center Volunteer

-Make and verify patient appointments
-File lab reports and charts
-Provide office support



Availability - Please indicate days and times of availability.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Morning
Afternoon
Evening

Desired Length of Commitment (please select one)
On-call (as needed for projects).
Community service hours (hours required each week)
Short term & seasonal (less than 6 months) hours per week
Long term (6+ months) hours per week

Location - Please indicate the location(s) in which you would like to volunteer.
Note: Some opportunities are not available in all areas.

Administration Office:
Overland Park (Suzanne E. Allen Center)
Health Center Locations:
Hays Independence
South KC North KC
Jefferson City Overland Park
Lawrence Midtown KC (Patty Brous Center)
Columbia Warrensburg
Wichita
Kansas Health Action Team Locations:
Johnson & Wyandotte County
Wichita


Education / Skills
High School Graduate College Graduate
Current Student - grade level:
Bilingual / Multilingual - language(s):
Biliterate / Multiliterate - language(s):
Special training or skills

Community or Volunteer activities


Have you ever been convicted for a violation of any federal, state, county, or municipal law, regulation, or ordinance? (Do not include misdemeanor or traffic violations, etc.)
Yes No

Questions - Please respond to the following.

1. How did you hear about PPKM's volunteer program?


2. Please state briefly why you are interested in volunteering for PPKM.


3. What do you know about Planned Parenthood and what we do?



Personal References - Please give the name, telephone number and relationship of two people we can contact for a personal reference.
1.


2.

Emergency_Contact_Information - Please indicate the name, telephone number and relationship of someone we can contact in case of emergency.
1.

I certify that all information provided on this application is true and complete. I authorize PPKM to verify the information provided. I understand that omission or falsification of information is grounds for refusal of my volunteer service or for my dismissal from volunteer service upon discovery.




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1-800-230-PLAN

Planned Parenthood of Kansas & Mid-Missouri

Care. No matter what.