Volunteer Application

Thank you for taking the time to complete this application. The general estimated time to complete the application is around 10 minutes. If you have any questions or concerns, please do not hesitate to send us a message or call us at 602-712-1006.

Your Information

First Name(Required)

Last Name(Required)

Preferred Name (if different than First)

Street Address(Required)

City(Required)

State(Required)

ZIP(Required)

Mobile Phone Number(Required)

Email Address(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Emergency Contact

Emergency Contact Name and Relationship(Required)

Emergency Contact Phone Number(Required)

References

Reference Name(Required)

Reference Phone Number(Required)

Reference Email Address(Required)

About You

Why would you like to volunteer at Cancer Support Community Arizona?(Required)

I am interested in volunteering at:(Required)

Main Campus: 360 E Palm Lane, Phoenix, Arizona 85006

Northern Arizona Campus: 914 N San Francisco Street, Suite G, Flagstaff, Arizona 86004

Virtual Only

What is your general availability to volunteer? (select all that apply)(Required)

Monday AM

Monday PM

Tuesday AM

Tuesday PM

Wednesday AM

Wednesday PM

Thursday AM

Thursday PM

Friday AM

Friday PM

Saturday AM

Weekends Only

Other

If you selected Other, what is you other availibility?

How did you hear about us? (i.e. health fair, website, social media)(Required)

Do you have any technical/professional skills, hobbies, or interests you would like to share?

Are you Bilingual English/Spanish?(Required)

Yes

If you answered "yes", may we contact you for Spanish speaking volunteer opportunities?

Yes

I am interested in volunteering in the following areas (select all that apply)(Required)

Community Advocate (outreach: table at events, physician offices, health fairs and conferences)

Front Desk (answer phones, greet guests, direct inquiries)

Data Entry/General Administration (help with mailers, data lists and inputting)

Event Collaborators (help with special events on/off campus)

Corporate Volunteer Groups for specific projects (landscaping, deep cleaning, fundraising)

Phone Volunteer (does not include requests for donations)

Peer Mentor/Mentee Program

Program Support (includes Latino Youth, Teen and Family, Healthy Lifestyle and Expressive Arts)

Cancer Support Community Arizona Background Check Policy

Our mission is to provide free emotional support, education and hope for people with cancer and their loved ones. Many of our participants and family members are vulnerable (physically, socially, emotionally, and spiritually). We appreciate each volunteer’s understanding of our responsibility to help protect all. Each background check is reviewed and evaluated with consideration given to such things as the magnitude, timing, frequency, type of offense, and which area of the program you will be assisting. If adverse information is disclosed in your background check, we may contact you to help review, evaluate, and determine your eligibility to serve at the present time. While it may happen, it is the exception, rather than the rule, that an individual is completely excluded from volunteering with CSCAZ.

Youth, Teen, and Family Program Volunteers Only: I have a state-issued fingerprint clearance card

Yes

If you answered "No" and are wanting to work with our youth, teen and family population, are you able to pay for a clearance card? (approx. $75.00)

Yes

Do you have any prior convictions or appealable offenses within the last 7 years that CSCAZ should be made aware?(Required)

Yes

If you answered yes, please provide explanation, including offense(s) and date(s):

Are you currently subject to a pending charge for any type of felony, misdemeanor, municipal ordinance violation, or any other like offense (other than a parking ticket or non-criminal traffic citation)?(Required)

Yes

If you answered yes, please provide explanation, including offense(s) and date(s):

In consideration of my desire to serve as a volunteer, I agree to release and hold harmless and fully indemnify CSCAZ, its officers, directors, sponsors, and employees from and against any claim or cause of action whatsoever arising out of my participation as a volunteer.

Please confirm statement by typing your first and last name.(Required)

I certify that the information in this application is accurate and complete. I certify I am 16 years of age or above and that my desire to volunteer is not court ordered community service. I agree to abide by the procedures and policies of Cancer Support Community Arizona during my volunteer service. I give permission to CSCAZ to contact the above reference and to obtain a background check. I understand that CSCAZ will notify me in advance if the position will also require fingerprinting or a more extensive background check.

Please confirm statement by typing your first and last name.(Required)

I do hereby give Cancer Support Community Arizona (CSCAZ), their assigns, licensees and legal representatives the irrevocable right to use my name, picture, photograph, portrait, life story, visual likeness, or voice in all forms and media in all manners, including photo, film, audio and video representations, for any lawful purpose whatsoever, including without limitation, for editorial, educational, promotional, and advertising purposes, and for the solicitation of contributions, and I hereby waive any right to inspect or approve the finished product that may be created in connection therewith. I hereby hold harmless and release and forever discharge Cancer Support Community Arizona from all claims, demands, and causes of action which I have or may have by reason of this authorization. I have read this release and am fully familiar with its contents.

Please confirm statement by typing your first and last name.(Required)

Rental Space Now Available at Cancer Support Community Arizona

At Cancer Support Community Arizona, our flexible conference rooms and outdoor patio provide the perfect setting for corporate meetings, team retreats, social events, and special celebrations.

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