Volunteer Application

Step 1 of 4

Name*
First Last
Address*
Street Address City State ZIP Code
Email*
Home Phone
Work Phone
Cell Phone*
Place of Occupation
Education and Degrees
Birthdate*
MM slash DD slash YYYY
Spouse's Name

Medical Information
All volunteers who plan to work in one of Alternatives' offices must provide the following information:
Medical Insurance Carrier*
Insurance Member ID*
Emergency Contacts
1st Contact's Name*
First Last
Emergency Phone Contact #1*
Relation to Contact*
2nd Contact's name
First Last
Emergency Phone Contact #2
Relation to Contact

Alternatives Pregnancy Center is a nonprofit organization that provides a safe and trusted environment to process a pregnancy decision, compromised sexual health or mixed emotions after an abortion. Privacy and confidentiality are a priority. Our compassionate and qualified staff take pride in offering holistic care to address physical, mental, emotional and spiritual health. All services are available at no cost. We do not provide emergency contraception. We do not refer for or perform abortions; therefore, Alternatives receives no financial gain from a pregnancy decision. We do not discriminate against anyone on the basis of sex, race, color, ancestry, religious creed, national origin, physical disability (including HIV/AIDS), mental disability, medical condition, age, sexual orientation, gender identity or marital status. We treat all people with dignity and respect.