3 Chapel Street
Canton, New York  13617
(315) 379-9845
renewalhouse@verizon.net

Renewal House

for Victims of Family Violence

Volunteer Application

Email:(*)
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First Name:(*)
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Last Name:(*)
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Phone Number:(*)
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Street:(*)
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City:(*)
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State:(*)
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Zip:(*)
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Are you applying for a Volunteer Position or Internship?
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Are you interested in Client-based Advocacy or Community Advocacy?
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If other please type here:
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New Advocate Training


In order to volunteer, the full 30-hour New Advocate Training is required.

Tentative Dates:

Check Back Soon.

Can you attend these dates?
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If no, explanation:
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Volunteer Preferences and Availability


Area of Interest(*)
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If other please type here:
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How did you learn about Volunteering at Renewal House?
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Have you been employed by or volunteered for Renewal House in the past?
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If so, when, and what service?
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Are you a former victim or survivor of domestic violence?
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Have you received services from Renewal House in the past?(*)
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If so, when did you last receive services from Renewal House?
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Are you proficient in a foreign language?(*)
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If so, which language or languages?
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Work and/or Volunteer Experience


Please give a record of recent (within 3 years) work and/or volunteer experience. (*)
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Please list THREE references; two professional and one personal (close friend or family member) to include: Name, Relationship, and Email Address. (*)
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Additional Questions


Describe the skills and experience you hope to gain through volunteering at Renewal House. (*)
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Describe any training, skills, or experiences, both professional and personal, that you could offer in your role as a volunteer at Renewal House. (*)
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Describe what you think a successful outcome would be when working with a victim of domestic violence or sexual assault. (*)
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Any additional information, views or comments you would like to add.
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Do you currently have any pending charges against you, or have you ever been convicted of, pleaded guilty of no contest to, been placed on probation, fined, imprisoned or incarcerated, or paroled for any offense (i.e. felony, misdemeanor, ordinance violation or forfeiture) other than minor traffic violations?(*)
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If your answer is yes, please explain the circumstances for each charge or offense. (NOTE: A pending charge will not automatically bar you from volunteering.)
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Verification(*)
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24 Hour Crisis Line

(315) 379-9845  

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