DVI AT BMC Application

IMPORTANT PROGRAM DATES
Friday, October 14, 2011: Time TBD
Saturday, October 15, 2011: Time TBD (DVI's Fall Conference)
Mandatory training for all IA and TL students: no exceptions!
Additional evening trainings for TLs: TBA
APPLICATION DEADLINE: Wednesday, Sept. 28

NOTE ABOUT FORM: ALL FIELDS MUST BE COMPLETED FOR SUCCESSFUL APPLICATION SUBMISSION. IF YOU DO NOT RECEIVE A FOLLOW-UP E-MAIL FROM US, YOUR APPLICATION HAS NOT BEEN RECEIVED!

Name:
Address:
City:
State:	Zip:
Home Phone:	Daytime Phone:
Email:
School/Year in School:
Do you have access to a car? Yes No	Gender: Male Female
Languages Spoken:
Please select the position for which you are applying. If you would like to be considered for more than one position, please check all that apply: Team Leader (must have experience working with DV clients; former BMC volunteers are encouraged to apply) Interviewer Advocate (experience considered but not required) Daytime Advocate (some experience required)
Please select the days when you are available to work at the hospital from 5pm-11pm one night every other week. Daytime Advocates will determine their shifts later on. Wednesday (5-11) Thursday (5-11) Friday (5-11) Saturday (5-11) Sunday (5-11)
What time does your last class end on the selected nights?
If you are applying to be a Team Leader, please indicate your availability on Monday and Tuesday evenings from 5-9pm:
Why are you interested in this program?
What do you expect to get out of your involvement in this program?
What relevant experience do you have working with issues of domestic violence? Have you advocated for individual clients?
Have you had any interviewing experience or worked directly with any type of clients? Have you worked in a low-income urban community?
How do you feel about working at night and/or on the weekends?
How did you learn about this program?
By submitting this form you are agreeing that all information on this application is accurate to the best of your knowledge.