Volunteer Application

Please complete and submit the following Volunteer Application. Upon submission, you will be directed to a confirmation page and requested to pay the $60 registration fee via PayPal. If you prefer, you can mail the registration fee to Trauma Intervention Programs, 4140 Oceanside Blvd., Suite 159-321 , Oceanside, CA 92056. If you have any questions, please contact us at (855) 847-7343 or info@tipsandiego.org.

Full Name

Home Address

City

State

Zip Code

Phone

Cell Phone

Birth Date

Employer

Occupation

Special Skills/Training

Requested Academy

In addition to on-scene support, what types of volunteer opportunities are you interested in:

If Other, please describe:

Have you had previous volunteer experience

Yes No

If yes, where?

Describe duties

How did you hear about TIP?

Do you have any allergies, physical limitations, or other health issues that are important for us to know?

Yes No

If yes, please describe:

Are you volunteering for school credit or community service?

Yes No

Why do you want to be a TIP volunteer?

Have you experienced a traumatic incident in your life?

Yes No

If so, when?

If yes, please explain:

Provide three references, not related by blood or marriage, all of whom you have known for at least 3 years.

Reference 1

Complete name

Years known

Address (include City, State & Zip)

Phone

Reference 2

Complete name

Years known

Address (include City, State & Zip)

Phone

Reference 3

Complete name

Years known

Address (include City, State & Zip)

Phone

Emergency Contacts | Please provide three people to contact in case of an emergency.

Name:

Relationship

Phone Number

Name:

Relationship

Phone Number

Name:

Relationship

Phone Number

Have you ever been convicted of a crime?

Yes No

If yes, please explain and provide date, charge, and other pertinent details:

Do you have any traffic violations in the last 10 years?

Yes No

If yes, please explain:

California Law requires that motor vehicle owners be covered by automobile liability insurance. Please provide the following information:

Insurance Carrier

Policy Number

I hereby affirm that the answers and statements provided in this application are true and correct.

Yes

Volunteer Application

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Volunteer Application

Stay Connected

Follow Us

Made with ♥ by WebSites San Diego Creative Design by R. Corral

Made with ♥ by WebSites San Diego
Creative Design by R. Corral