Client Care Application

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The following chart is a window into our history.
	1981	2007
People Served	3,109	16,333
Volunteers	10	335
Offices	1	5

Client CareVolunteer Application

Please complete this application only after viewing our Volunteer Orientation.

* denotes required field

Have you viewed the Volunteer Orientation? Yes No

Name: *

Address: *

City: *

Zip: *

Home phone: *

Cell phone:

Work phone:

Email address: *

Date of birth (without year): *

Are you 21 years of age or older? * Yes No

Educational background: *

Occupation (if applicable):

Employer:

Languages spoken (other than English):

Marital status: *

Spouse's name (if applicable):

Spouse's place of employment (if applicable):

How does your spouse and/or family feel about your involvement with PDHC? *

Number of children (if any):

Age(s) (if applicable):

Name of local church:

Previous volunteer experience:

How did you learn about PDHC?

What made you interested in volunteering at PDHC?

Please describe any previous experience you have had involving an abortion or
unplanned pregnancy:

Are there any issues or events in your life that could affect your volunteer work?

When are you available to volunteer (e.g., day of the week, daytime/evening, etc.)?

Please check the volunteer opportunities you are most interested in pursuing:

Medical Clinics:

North Medical Clinic West Medical Clinic East Medical Clinic
Campus Medical Clinic

Other:

H.E.A.R.T. 24-Hour Hotline

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