"Glorifying God by Connecting the Sexually & Relationally Challenged to Jesus Christ."

Confidential Volunteer Intake Form


New Hearts Outreach
Confidential Volunteer Intake Form
Thank you for considering giving New Hearts Outreach the generous gift of your time and abilities. We are a Christian, healing and discipleship ministry committed to the wholeness of individuals wrestling with a range of sexual and relational challenges, and now you too can partner with us in this rewarding work. The first step is to fill out this Confidential Volunteer Intake form. Required fields are marked with an asterisk. Please fill out all other fields as you are comfortable. The next step will be to schedule a 30-minute, confidential, intake interview. After you submit your form, one of our staff will be in touch with you within 2 business days to schedule an interview.
 
*Date:
*Please Check All That Apply: Male Client Female Client Pastor Counselor Parent
                                                SpouseFriend Other
*Age:
*DOB:
Race:
*Name: *Last  *First  MI
Organization:
*Address: *Street Address Line 1
                 Street Address Line 2 
                 *City:  *State:  *Zip Code:
*Phone No. (Please list at least one phone no.)
                   Home
                   Cell   
                   Work   Ext.
                   Fax   
Email:
Vocation:
*Emergency Contact Info: *Name  *Relationship
                                         *Phone No.  Ext.
*How would you prefer us to contact you? Home Phone Cell Phone Work Phone Email
*When is the best time to reach you? Morning Afternoon Evening Anytime
Please identify what day(s) and time(s) you prefer to schedule a 30-minute, confidential, intake interview. We will
try our best to accommodate you.
*Would you like to receive our newsletters and other publications via mail and/or email? Yes No
Why would you like to volunteer with New Hearts Outreach?
 
Please describe your what your availability looks like to volunteer.
 
 
Please list your relevant set of office and/or ministry skills and experiences.