HAND Volunteer Application

Please provide the following information:

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* 1. Please provide the following information:

First and Last Name:

Email:

Phone Number:

Street Address:

City/State/Zip:

Please briefly describe your experience with pregnancy/infant loss:

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* 2. Please briefly describe your experience with pregnancy/infant loss:

If you have experienced a pregnancy/infant loss, please provide the date(s) of your loss(es) and name of baby/babies (if named):

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* 3. If you have experienced a pregnancy/infant loss, please provide the date(s) of your loss(es) and name of baby/babies (if named):

Do you have other children?

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* 4. Do you have other children?

Yes

If yes, names and ages

What is your experience with HAND? (check all that apply)

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* 5. What is your experience with HAND? (check all that apply)

Attended grief support meetings

Attended subsequent pregnancy support meetings

Received 1:1 peer support from a HAND volunteer

Attended Service of Remembrance

No prior experience with HAND

Other (please specify)

What are your volunteer interests?

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* 6. What are your volunteer interests?

Support group meeting facilitator

Bereaved Parent Playgroup Coordinator

Peer support (1:1 support via phone and/or email)

Board of Directors

Event planning (Service of Remembrance, Volunteer Picnic)

Administrative support

Fundraising

Technology (webmaster, data entry)

Community outreach

Newsletter

Other (please specify)

Please explain what you hope to contribute through your volunteer work with HAND:

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* 7. Please explain what you hope to contribute through your volunteer work with HAND:

Do you have any special skills that you would like to offer in support of HAND? If so, please describe:

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* 8. Do you have any special skills that you would like to offer in support of HAND? If so, please describe:

Do you speak any other languages fluently?

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* 9. Do you speak any other languages fluently?

Yes

If yes, which language(s)

Additional information you would like to relate (experience, concerns, questions)?

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* 1. Please provide the following information:

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* 2. Please briefly describe your experience with pregnancy/infant loss:

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* 3. If you have experienced a pregnancy/infant loss, please provide the date(s) of your loss(es) and name of baby/babies (if named):

Question Title

* 4. Do you have other children?

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* 5. What is your experience with HAND? (check all that apply)

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* 6. What are your volunteer interests?

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* 7. Please explain what you hope to contribute through your volunteer work with HAND:

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* 8. Do you have any special skills that you would like to offer in support of HAND? If so, please describe:

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* 9. Do you speak any other languages fluently?

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* 10. Additional information you would like to relate (experience, concerns, questions)?