*Important Note*: The email address you use for the purposes of this application will be the main way that UHPP's Volunteer Coordinator will communicate with you. Check your Spam folder for emails from "madeliner@uhpp.org"

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* Today's date

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* First Name

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* Last Name

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* Pronouns

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* Address *If you are uncomfortable providing your full address, please provide your Zip Code, as we identify volunteers for specific health centers based on your location.*

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* Phone number

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* Email address *If you are a student, please provide your personal email, rather than your school email, so that we can reach out with opportunities to volunteer even after you have graduated!*

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* What is the best way to reach you?

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* Would you like to be added to UHPP's email list?

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* Where are you based/Which PP Health Center is most convenient for you to get to for a volunteer opportunity?

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* What is your occupation?

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* Employer school or attending?

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* Please list any knowledge and/ or personal experience you have with reproductive health care, advocacy and/or education.

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* Why do you want to volunteer with Upper Hudson Planned Parenthood?

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* Please rank our volunteer opportunities from (1) as being most interested in, to (7) being least interested in. If you want more context about what each of these roles entail, check out our website.

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* What is your availability?

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*  Any restrictions on your availability?

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* Can you commit to the volunteer program for a specific amount of time?

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* If yes, how long?

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* Have you ever been convicted of a crime?

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* If yes, please explain:

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