Paper version of the Volunteer Application Form Today's date First name (required) Middle initial (required) Last name (required) Date of Birth Address (required) City (required) State (required) Zip (required) Phone (required) Email (required) Emergency Contact Name (required) Emergency Contact Phone (required) How would you like to help? (required) NAMIWalksAppleton Farmer's MarketSpecial EventsGardeningFundraisingNAMITalks Speaker BureauReceptionMailingsOther Why do you want to volunteer with NAMI Fox Valley? (required) What kind of volunteering experience have you had in the past? What skills do you have that you would like to share with NAMI Fox Valley? (required) Any other names by which you have been known (including maiden name)? Do you have any criminal charges pending against you or were you ever convicted of any crime(not including traffic violations)? (required) YesNo If yes, list each crime, when it occurred or the date of conviction, and the city and state where the court is located. You may be asked to supply additional information. Have you resided out of the state of Wisconsin in the last three years? (required) YesNo Give the name and phone of two non-family members who can provide references on your ability to perform this volunteer position. Name (required) Relation (required) Phone (required) Email (required) Name (required) Relation (required) Phone (required) Email (required) NAMI Fox Valley performs background checks on all volunteers for the safety of our consumers and their family members. Completed forms will be kept in a secure location to protect your confidential information. Answering affirmatively to any questions will not necessarily bar you from volunteering with NAMI Fox Valley. However, failure to comply or providing false information may result in denial or termination of volunteer activities. I accept these conditions You must accept those conditions to apply.