BCAP Volunteer Application

Please fill out the appliation form and click the Submit Form button at the end. This will email the Volunteer Coordinator with your application.

If you prefer, you may print the form and mail it to BCAP. Click here to download a PDF copy of the application.

First Name
Middle Initial
Last Name
Nickname
Email address
Phone Numbers

Home:

Work:

Cell:

May we call you at work?


Address

Birthdate
Employer Information

Employer:

Occupation:

If you are a student, what is your school and field of study
Community or church affiliations
Please list languages spoken, besides English
Please select which of the following (if any) you have

car
truck
other vehicle
driver's license
auto insurance
How were you referred to BCAP?

Emergency Contact Information

Name:

Relationship:

Day time phone:

Evening phone:

I am interested in helping with:

HIV Care Services
HIV Prevention Services
Special Events
Administration
Facilities Maintenance
Other
Do you have any professional skills that you would be willing to donate to BCAP?
When are you available to voluntter?

weekdays
weekday evenings
weekends

The following information will be used when BCAP is reporting statistical information to financial grantors.
Race / Ethnicity
Gender
Education Level
Age
Sexual Orientation
Income Level
Why are you interested in volunteering for BCAP?
Describe your current and/or previous volunteer experience.
How has HIV / AIDS or other serious illness impacted your life?
Describe any major life changes you've experienced in the past 12 months (e.g., long-distance move, divorce, death in the family, etc.)
Do you have any personal health concerns that might impact your work as a volunteer? (e.g., chronic fatigue, arthritis, cannot lift, etc.)
Have you ever been convicted of a crime, other than a traffic violation?



If yes, please describe:

References

Please list one personal and one school or professional related reference. (Please include names, addresses, phone numbers)
BCAP respectfully requests a commitment of one year from all volunteers. Is this realistic for you?



   

I have read and am in agreement with the mission and services of the Boulder County AIDS Project. I confirm that the information supplied on this application is true and correct. BCAP has my permission to contact my references. I realize that I will not be accepted as a BCAP volunteer until I have completed an interview with the Volunteer Services Coordinator.
Volunteer Signature (type your name in lieu of signature)
Date (month, year, day)
Signature of Parent/Guardian (if volunteer is under 18 years of age)
Date (month, year, day)

Policy on Confidentiality

Confidentiality is a fundamental policy at BCAP; staff and volunteers are instructed that the following information is confidential:

The fact that someone:

  • is a client, has AIDS, is HIV-positive, is HIV-negative, has been tested for HIV antibodies
  • is a volunteer or used to be a volunteer
  • is a donor or contributed money
  • has been at BCAP (whether to receive services or not)

 

Any personal information about a client, volunteer or staff person that was learned at BCAP, including:

  • medical condition
  • medical, psychological or holistic treatments
  • finances or insurance arrangements
  • living arrangements
  • employment (except BCAP staff)
  • sexual orientation or activity
  • relations with biological family members, partners or friends

 

All clients and other callers have the right to expect that BCAP will maintain confidentiality of information, documentation, and records pertaining to the services except as otherwise provided by law. Clients will be asked to sign specific releases of information for any records, documentation or information to be shared with any other individual or agency. (This does not apply to any statistical data, which may be required by funding agencies where the client's identifying information is not made known.)

I have read and understand the above policy.
Volunteer Signature
Date

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