MSU Center for Survivors Volunteer Application The sensitive nature of our work necessitates that we ask questions of a personal nature, which will be kept confidential. We need this information in order to make appropriate job assignments so you will have a rewarding volunteering experience and so we can accommodate special needs/concerns that you may have. In order to volunteer with our program, you will be required to complete the Sexual Assault Crisis Intervention (SACI) Core 32 hour training and your application will be subject to a criminal background check. In order to volunteer as a Medical Advocate you will be required to complete an additional 10 hour Medical Advocacy training. Name: ___________________________________ Today’s Date: _____/_____/_______ Local Address: Date of Birth: _____/_____/_______ _________________________________________ Phone Number: ______________________________ _________________________________________ Pronouns: ___________________________________ Permanent Address (if different than above): E-mail address: ______________________________ _________________________________________ _________________________________________ Do you speak any languages in addition to English? YES NO If yes, what? ____________________________________________________________________ How did you hear about this training? ________________________________________________________________ If you are a student, please answer the following questions: Major/Year: _________________________________________ Student ID# _______________________________ Anticipated Graduation Date: _________________ Requirements to Volunteer: 1. Complete Volunteer Application, participate in Interview, Criminal Background Check, and MSU Student Conduct clearance (if affiliated). 2. Attend ALL mandatory 32-Hour Sexual Assault Crisis Intervention Core Online Training including self-study and live synchronous meetings via zoom as indicated below: • • • • Sunday, June 6th 1-5pm EST Wednesday, June 16th 6-8pm EST Saturday, June 19th 1-5pm EST Sunday, June 27th 1-5pm EST 3. Complete the mandatory 10 hour Medical Advocacy training, 6 hours self-study to be complete beforehand. • Wednesday, July 7th 6-8pm EST • Wednesday, July 21st 6-8pm EST 4. Complete two shifts per month (shifts may be Hotline, Crisis Chat, Medical Advocacy, or Outreach/Safe Space) & one-year commitment. 5. Attend mandatory volunteer meetings held every Monday throughout the school year from 6-7pm. (In case of conflict, individual appointments may be scheduled with the Volunteer or Care Coordinator.) MSU Center for Survivors reserves the right to determine which services, if any, a volunteer may provide under the supervision of the MSU Center for Survivors and reserves the right to deny the opportunity to volunteer to any person at any time or dismiss them from the program at any time for any reason. Please sign here to confirm you have read the volunteer requirements: 1. Why do you want to volunteer for the Center for Survivors? 2. What knowledge, skills, abilities or experiences working with a team do you possess that will help you contribute to our program? 3. Please describe any personal or professional experiences you have had dealing with sexual assault or relationship violence (family, friends, self): 4. Please describe your support systems and ways you manage stress: 5. What do you think will be the most challenging about volunteering with our program? The most rewarding? 6. Volunteer shifts at the Center for Survivors involve taking 24/hour on-call shifts, during which you are available to respond to a hotline call, a crisis chat, or a SANE exam at the MSU Sexual Assault Healthcare Program. How do you feel about being on-call? Do you anticipate any barriers or challenges to providing on-call coverage for a minimum of 2 shifts per month? 7. Medical Advocacy shifts require that you be able to respond in-person to the MSU Sexual Assault Healthcare Program located on the MSU main campus in East Lansing, within 30 minutes of receiving a call. Do you live within a radius that would allow for this response time? ACCOMMODATIONS: Michigan State University is committed to providing equal opportunity for participation in all programs, services and activities. Accommodations for persons with disabilities may be requested by listing them here. Requests will be honored whenever possible. YES NO If yes, please describe: Submission Instructions Please su

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