Your Name (required)

Your Email (required)

Subject

Your Message

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Applicant's Information

Name (required):
Street Address (required):
City (required):
State (required): ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code (required):
Home Phone (required):
Work Phone:
Email Address (required):
Preferred Contact Method (required):
EmailTextPhone CallFacebook Messenger (please provide Facebook Name below)Other
Other contact method or provide Facebook Name if selected above)

What interests you most about volunteering with CLIMB? (Required - Choose all that apply)
Helping othersBeing part of something biggerUsing my skillsServing Christ by serving othersMeeting new peopleMaking a differenceSharing my faithInternational TravelBeing part of a groupOther

What gifts would you like to utilize while volunteering with CLIMB? (Required - Choose all that apply)
AdministrationEventsFundraisingPublicity/MediaVolunteer coordinationOther

List special skills and qualifications you have gained from employment, previous volunteer work, or through other activities that may be a blessing to CLIMB for Haiti. (Required)

Describe your previous volunteer experience. (required)

What church do you attend? (Not a requirement to volunteer)

Church Name and Address:
Pastor's Name:
Pastor's Email:
CLIMB is a faith-based organization. What, if any, role does faith play in your life?

Person to notify in case you have an emergency:

Name (required):
Street Address (required):
City (required):
State (required): ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code (required):
Home Phone (required):
Work Phone:
Email Address (required):

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.
I agree.