Catholic Charities of the Archdiocese of Omaha, Inc. : Donate and Help : Mentoring Moms Volunteering

Mentoring Moms Volunteering

Please complete this application form if you are interested in becoming a Catholic Charities volunteer. Items marked with an asterisk (*) are required pieces of information. Once you complete the form, click the Continue button at the bottom of the page.

Thank you! Volunteers DO make a difference.

Contact Information

Name (Required)

First Name

Last Name

Address (Required)

Country

Address Line 1

Address Line 2

Address Line 3

City

State

Postal Code

Phone (Required)

Email Address (Required)

Why do you want to be a mentor? (Required)

How do you think you will benefit from being a mentor? (Required)

Additional Personal Information

Date of birth is a required field to determine additional steps needed for those 18 years or younger.

Date of birth: (Required)

Education (Required)

Do you have any bilingual experience? In what language? (Required)

How did you hear about our program? (Required)

Availability

Which days/evenings are generally better for you to spend time as a Mentor? (You will not be held to this, but it may aid us in pairing you with a mentee).

Days of the week + Morning, Afternoon, Evening (Required)

My availability is: (Required)

From:

To:

Can you make at least a twelve month commitment? (Required)

Can you attend periodic mentor group meetings? (Required)

Can you meet or phone your mentee weekly? (Required)

Please answer the following questions.

Please describe your employment experience for the last ten years. (Required)

Please describe volunteer experience in the last ten years that you have enjoyed. (Required)

Do you have particular talents, personal characteristics, or special insights, which would be beneficial to particular mentees? (For example, did you have children at a very young age, do you have many children, or have your overcome particularly difficult odds?) (Required)

Is there any other information that you feel will aid us in pairing you with a mentee? (Required)

Do you have concerns about the program? (Time commitment, other commitments that may interfere, business travel, personality conflict, money, developing a one-on-one relationship, etc.) (Required)

What assistance or other support can the Mentoring Moms Program provide to you? Any other questions or concerns? (Required)

Emergency Contact 1

Please provide information for two emergency contacts.

Name (Required)

First Name

Last Name

Address (Required)

Country

Address Line 1

Address Line 2

City

State

Postal Code

Phone (Required)

Relationship (Required)

Emergency Contact 2

Name (Required)

First Name

Last Name

Address (Required)

Country

Address Line 1

Address Line 2

City

State

Postal Code

Phone (Required)

Relationship (Required)

References - Mentoring Moms Program

Volunteers who are applying to volunteer in the Mentoring Moms program are required to provide three personal and/or professional references that are not relatives.

Name (Required)

First Name

Last Name

Address (Required)

Country

Address Line 1

Address Line 2

City

State

Postal Code

Phone (Required)

Relationship (Required)

Reference 2

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Name (Required)

First Name

Last Name

Address (Required)

Country

Address Line 1

Address Line 2

City

State

Postal Code

Phone (Required)

Relationship (Required)

Reference 3

Name (Required)

First Name

Last Name

Address (Required)

Country

Address Line 1

Address Line 2

City

State

Postal Code

Phone (Required)

Relationship (Required)

Has anyone ever been a mentor to you? If so, please briefly describe the relationship and why you believe that the relationship was successful or not successful. (Required)

Demographic Information

It is the policy of Catholic Charities of Omaha to provide equal opportunity for all without regard to race, color, national origin, religion, gender, age, disability, marital status, veteran status or genetic information or any other prohibited basis under applicable federal state or local law.

The requested information below is voluntary. This information will only be used for reporting purposes.

Gender

Race/National Origin

Agreement

TERMS & CONDITIONS OF VOLUNTEERING
All volunteers should have their own medical insurance. If a volunteer requires medical/hospital attention due to an incident that occurs while volunteering for Catholic Charities, whether it was a direct result of the work they were instructed to do or not, that volunteer’s own medical carrier will be responsible for all medical coverage. The volunteer is expected to report any injury while volunteering immediately to their supervising staff person.

By checking "I agree" below, I am stating that I have read and understand the Terms and Conditions of Volunteering.

RELEASE OF LIABILITY
In consideration for being allowed to participate as a volunteer for Catholic Charities, I do hereby release and discharge Catholic Charities, its assignees, officers, agents, employees, and officials and their successors from any and all liability that may be received by me (or by minor child) from all claims and demands of any personal injury to me, damage to my personal property, automobile, or any other personal items, as a result of my willful participation. I further affix my signature to acknowledge that I have reviewed such “Terms and Conditions of Volunteering”, and I do willfully elect to participate as a Catholic Charities volunteer at my own risk.

By checking "I agree" below, I am stating that I have read and understand the Release of Liability.

CONFIDENTIALITY GUIDELINES
Respect for confidentiality is an important ethical principle that guides all Catholic Charities activities and provisions of service to clients. The agency strives to protect the privacy of the relationships established with clients, employees, volunteers and other related groups. This means that the identity and records of clients recognized at Catholic Charities are to be protected. If you encounter someone known, it is preferable to let that person greet you first, as he/she may not wish to acknowledge knowing you. Encounters with persons who are clients and identifying information about clients should not be discussed except, when the work requires it, with Catholic Charities staff members or other volunteers.

In addition to moral and ethical demands for confidentiality, identifying information about clients is protected by Federal regulations, including 42 CFR, Part II, which applies to information about alcohol and drug abuse clients. Catholic Charities complies with all of these federal regulations. The fine for wrongful release of such information can be $5,000 or more.

Regarding other types of information, Catholic Charities has identified specific employed personnel as responsible for releasing any information. A volunteer must always refer requests for information to an appropriate employee, generally the person supervising the volunteer’s work.

By checking "I agree" below, I am stating that I have read and understand the Confidentiality Guidelines.

Agreement

I have read and understand Catholic Charities’ Terms and Conditions, Release of Liability, and Confidentiality Guidelines stated above and agree to abide by them.

I Agree