Volunteer Application Form

Which role are you applying to? *

Volunteer Applicant

Name Prefix

First Name *

Last Name *

Street Address

Street Address Line 2

City *

Post Code *

Birth Date *

Day

Month

Year

Email *

Telephone Number

Mobile Number *

References

Please give the names and contact details of two people, unrelated to you, who would give you a personal/professional reference

Reference One

First Name *

Last Name *

Email Address *

Role *

Relationship to you *

Reference Two

First Name *

Last Name *

Email Address *

Role *

Relationship to you *

Criminal convictions

Please give details of any criminal convictions (if applicable) so that we can take them into account when considering your application

Please give details of any criminal convictions (if applicable) so that we can take them into account when considering your application.

How did you find out about volunteering for Aphasia Support?

If "Other" please state where

Equal Opportunities monitoring

Aphasia Support would like you to answer the following questions. This information will only be used to provide us with statistics to show us where we need to target our volunteer recruitment. This will help us to make sure Aphasia Support welcomes volunteers from all areas of society.

Gender

Disability

Yes

Prefer not to say

Age group

How would you describe your sexual orientation?

What is your religion or belief?

Ethnic origin

Other ethnic group

Volunteer Profile

Your volunteer profile is shared with the client you are matched with prior to you meeting them for the first time. You will also receive a completed client profile prior to the first appointment.

Occupation

Volunteer Role

Do you have any pets? And what are they called?

Hobbies and interests

e.g. sports, reading, crafts, travel…

What is your favourite type of music or singer/musician?

What are your top five favourite films?

Film 1

Film 2

Film 3

Film 4

Film 5

Favourite food and drink…

Family and friends: parents, brothers/sisters, cousins, best friend…

Why you choose to volunteer: e.g. to support your studies, to help people, to give something back…

Things you would like to achieve in the next 5 years…

Anything else you’d like the client to know about you…

Consent

I consent to you collecting and using my special data in surveys to measure the impact of the charity’s work and so that you fulfil your responsibilities relating to funding bids, specifically the Big Lottery Fund

I consent to you using my email/postal address to send me the charity’s quarterly newsletter, and any other Aphasia Support news you think may be of interest to me