Full Name *

Thank you for your interest in becoming a Counselor/Adult Mentor for Camp HOPE America, Tehama. You have the amazing opportunity to become a very significant part of a child’s life and make a life-changing impact. We take the process of finding Counselors and Adult Mentors very seriously because we deeply care about our participants and the kind of guidance and love that they receive during their week of camp. We are looking for individuals who are compassionate, encouraging, empathetic, kind, sensitive, patient, and adventurous. We look forward to learning more about you to see if you might be a good fit for our mission and vision of changing the destinies of children exposed to family violence through the modality of camping and ongoing relationships.

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Reference #1 Name *

First Name

Last Name

Reference #1 Phone *

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Reference #2 Name *

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Last Name

Reference #2 Phone *

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Full Name *

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Last Name

Date *

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Home Phone *

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Alternate Phone *

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Are you over 18 years of age? *

Yes

No

Please indicate areas you are interested in volunteering. *

Events

Fundraising

Spanish-speaking translator for events

Child Care Assistance

Shelter/Operations Assistant

Crisis Hotline

Administration

Legal Advocacy

Other

Empower Tehama is an equal opportunity agency and does not discriminate on the basis of race, religion, color, sex/gender and sexual orientation, national origin, ancestry, physical or mental disability, medical condition, genetic information/characteristics, marital status/registered domestic partner status, age (40 and over), sexual orientation, military or veteran status and any other basis protected by federal, state or local law or ordinance or regulation. *

Empower Tehama conducts background checks on all volunteers. Background checks are conducted only after a prospective volunteer has interviewed, in-person, with Empower Tehama. Prospective volunteers are encouraged to provide any explanations they wish to have considered regarding items that may appear on their background check at the time of interview. Volunteer acceptance is determined on a case-by-case basis.By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

First Name

Last Name

Agreement and Signature *

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

First Name

Last Name