Community Befriending Scheme

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					                                                                 Mind in Harrow
                Community Befriending Scheme

                   Volunteer Application Form


First Name ………………………………… Surname ………………………………

Address …………………………………………………………………………………

          …………………………………………………………………………………

Post Code ……….. ………………………... Date of Birth ………….……………

Telephone: Home ……………………………Work …………………………………

            Mobile ……………………………E-mail ............................................

Gender:   Male / Female

Occupation: ……………………………………..………….. Full-time / Part-time

Language(s) spoken other than English (please say how fluently):

…………………………………………………………………….………………………..
.

How did you hear about us? …………………………………………………………


Please say briefly why you are interested in working with Mind.

………………………………………………………………………………………………

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Do you have any experience of supporting people in mental or emotional
distress? (This could be as a paid worker, a volunteer or a friend/relative.)

………………………………………………………………………………………………

………………………………………………………………………………………………

………………………………………………………………………………………………

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Do you have any personal experience of mental or emotional distress?
Please give brief details if you wish.

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Do you have any other experience or training which you feel would be
helpful to you as a Mind volunteer?

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Do you have any health problems which could prevent you from taking part
in certain activities as a volunteer (e.g. sports, helping someone with a
physical disability)?

………………………………………………………………………………………………

………………………………………………………………………………………………


Would you have use of a car for your voluntary work?               Yes / No

What are your hobbies and interests?

………………………………………………………………………………………………

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What is your religious /cultural background? [You do not have to answer
this question but if you are interested in befriending it may be helpful in
matching you with a scheme user.]



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………………………………………………………………………………………………

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Do you have any experience of different cultures?

………………………………………………………………………………………………

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Please give the names and addresses of two people whom we can ask for a
reference. They should have known you for at least two years and be able
to speak about your suitability as a Mind volunteer. They should not be
related to you or living with you.
NB One referee should be someone who has known you in a professional
capacity.

[1]   Name ……………………………………………………………………………

      Address …………………………………………………………………………

             ……………………………………………………………………………

      Tel. No. ……………………………………………………………………………

[2]   Name ……………………………………………………………………………

      Address …………………………………………………………………………

             …………………………………………………………………………….

      Tel. No. ……………………………………………………………………………

                                                                  P.T.O.




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POLICE CHECKS
Because Mind in Harrow works with vulnerable people, it is our policy to
carry out police checks on all staff and volunteers. Acceptance as a
volunteer is subject to a satisfactory police check.

If you have had a recent police check, please send it in a separate envelope
marked Private: for the attention of Chandrakant Shah. We will return it to
you.

You have the opportunity at this stage to declare any criminal convictions,
spent and unspent. To do so, please send a letter in a separate envelope
marked Private: for the attention of Chandrakant Shah




I apply to be a volunteer with Mind in Harrow.

Signed ……………………………………………………………………………………

Date ……………………………………………………………………………………….




                              Please return to:

                Befriending Services Co-ordinator
                         Mind in Harrow
                      132-134 College Road
                             Harrow
                       Middlesex HA1 1BQ

                          Tel: 020 8426 0909
                    e-mail: info@mindinharrow.org.uk




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posted:9/17/2012
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