VOLUNTEER APPLICATION
Thank you for your interest and support! As part of our Planned Parenthood volunteer team you can become part of something you believe in. The information on this form will help us find the most satisfying and appropriate volunteer service for you.

Name:  

Address:  

City, State, Zip:  

Email:  

Phone Number:  

Yes, it is ok to identify yourselves as Planned Parenthood when calling: 

I am over 18 years of age: Yes  No

How did you first learn of Planned Parenthood?


How did you learn about volunteer opportunities at Planned Parenthood?


Experience/Skills:
Please describe any general or specific skills (paid and volunteer) you feel would be helpful in your volunteer work at Planned Parenthood (e.g., customer contact, computer skills, public speaking, written communications, leadership, fluent languages)

Community Affiliates:

Why have you decided to volunteer at Planned Parenthood at this time?

In what way(s) would you like to volunteer at Planned Parenthood?


Please choose the department and location you are interested in volunteering:
Statewide - Health Center (in/near your city)  
Madison - Activism/Public Affairs Department 
Madison - Development Department  
Milwaukee - Activism/Public Affairs Department 

Days and times you are generally available to volunteer? (example: Monday 10am-2pm; Thursday 6pm-8pm; Saturday all day)

How do you feel about the fact that Planned Parenthood offers confidential services to minors, including access to contraceptives?

Planned Parenthood is a pro-choice organization and supports a woman's right to choose abortion, adoption or parenting when pregnant.  How do you feel about volunteering for an organization that supports and provides these services?



Confidentiality Agreement:
Your volunteer position may expose you to confidential information and records. Under no circumstances can you reveal this information except as may be required in the course of your work or by law. PPWI will immediately terminate any volunteer who breaches confidentiality about patients, internal financial and management matters, staff members, donors, or other volunteers. Unauthorized use or disclosure by you of any such information constitutes a breach of promise of your volunteer commitment to PPWI and may subject you to court action by any interested party and/or to other sanctions by PPWI.

By signing below, you agree to maintain the confidentiality of all information, even after your active volunteer status has ended, and certify that all information provided is true and complete and authorize PPWI to verify information provided.

Type your name and today's date as your signature:




[to send this form electronically, please click "OK" and then "Yes" on the pop-up windows after you Submit.  This form will be sent as an email through your provider.]