Application Form

PRSG Volunteer Application Form

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* Indicates required field

Today's Date (month/day/year) *

Legal Name *

First

Last

Preferred Name / Nickname - if different (optional) *

Email (please make sure it's correct) *

Cell Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Gender *

Male Female Other

Are you a US citizen or have a social security number? *

Yes No Other

Other (explain below) *

Note that we are not asking for your social security number, but you must have a social security number to volunteer with us.

How old are you? *

Date of birth (month/day/year) *

Note that you must be 18 years of age or older to volunteer

Name of emergency contact *

First

Last

Relationship *

Cell Phone *

Have you had a background check recently? *

If yes, can you provide us with a copy of your background check ASAP? *

Besides English, what languages do you speak? *

If you speak both English and another language, are you willing to interpret or translate for refugees if needed? *

What's your occupation? *

Core Volunteer & Volunteer Tutor Overview
In general, our families need help navigating life in America. We encourage you to treat them as your own family.

As a Volunteer Tutor, you will spend about 2 hours, once per week with your family on Zoom. Our Tutor Coordinator will match you with a refugee family. She has many resources and teaching materials that can help you.

As a Core Volunteer, you will call/Zoom your family once per week to see how they’re doing and if they need any assistance. Your duties may include helping your family with the following:

Making appointments or responding to contacts, such as schools, hospitals or government agencies, etc. If you need an interpreter and can’t find one, our Refugee Affairs Coordinator may be able to help.
Financial aid and benefits. If your family needs help paying bills or other expenses, we have a Resources page on our website that you can use, plus you can find other ones online. If you exhaust all resources and fail to find help, you can fill out our Financial Aid form, which is on the same Resources page.
Transportation. You don’t have to do this, but if you wish, you can assist your family with your own means of transportation, whether to an appointment or to the park for some fun. Or you could help them navigate public transportation or rideshare.

Which role are you interested in? Note that you can choose more than one *

Core Volunteer Other

Other (please specify) *

Are you interested in tutoring as well, if there is a need? *

What abilities, experiences or interests do you have that may be beneficial to PRSG? *

Note that you can request to add or change your volunteer position(s) at any time.

I understand that, if assigned to a family, I am expected to contact my refugee family once per week

If you have any program suggestions please let us know *

What are your personal goals for this experience? *

How many hours per week are you willing to commit to? *

Do you have a specific number of volunteer hours you want to complete for school, work, etc? If yes, how many hours total? *

Is there a specific client you would like to help? *

I will inform PRSG administration if I'm unable to volunteer temporarily or permanently

I will provide my status update every 3 months, when asked

I will provide my monthly hours of volunteering, when asked

Do you have any health issues or limitations that we should be aware of? *

I will email PRSG a picture of a valid photo ID, ASAP (for safety, please cover ID #)

I will email PRSG my photo (headshot), ASAP

I will email a copy of a recent background check or have one done through PRSG, which costs $39, or $25 for volunteers between the ages of 18-23

I agree to give my time and services to Portland Refugee Support Group without financial compensation and will not accept monetary gifts from clients. I agree to respect clients’ right to self-determination and help them attain their independence and self-sufficiency. I agree to report suspected abuse or neglect to a Portland Refugee Support Group staff member. I agree to promptly submit any required reports and monthly volunteer hours performed. I agree to inform the Volunteer Coordinator if I am unable to volunteer due to illness or emergency and keep them informed regarding my volunteer status and/or any on-going client needs. I understand that a background check will be performed on civil, criminal, and motor vehicle records (as appropriate). Confidentiality information about Portland Refugee Support Group clients, their families and their personal lives are to be kept confidential. Volunteers are prohibited to disclose or release client information without the proper consent of the client involved. This includes not speaking to other professionals (teachers, doctors, etc) without a Release of Information being obtained from Portland Refugee Support Group. Exceptions to this policy include disclosed or observed child, elder or other person abuse or neglect; disclosure by clients of intent to harm self or others; a medical emergency (only necessary information) and the disclosure of information required by court subpoena. Confidential documents must be disposed of by utilizing designated paper shredding machines. I understand that unauthorized use or disclosure of protected and confidential information, including information a client may share with me directly, will result in disciplinary action up to and including termination of my volunteer position. Waiver of Liability: I agree that before or during my volunteering, if I believe anything is unsafe, I will immediately advise a Portland Refugee Support Group board member. I acknowledge that I may be engaging in activities that could involve risk of injury or other loss. I assume all the foregoing risks and accept personal responsibility for the damages following injury. I hereby release and forever discharge and hold harmless Portland Refugee Support Group, or any of its staff, volunteers and/or clients, from any and all liability, claims and demands of whatever kind or nature, either in law or in equity that arise or may hereafter arise from my volunteer activities. Portland Refugee Support Group policy requires that volunteers who opt to drive clients in their personal vehicle carry 100/300/100 minimum liability automobile insurance. I understand it is my responsibility to maintain a valid driver’s license and vehicle insurance that complies with state law. In the event of an accident, the volunteer’s insurance is primary. I consent to the use, publication and reproduction of any photograph or interview taken of me by Portland Refugee Support Group, or its agents, for publicity and non-commercial advertising purposes without compensation. I waive the right to make any claim arising out of the use of such photographs/recordings and understand this release shall inure to the benefit of Portland Refugee Support Group, its successors, affiliates and assigns. I agree to all terms of the Volunteer Agreement as outlined above. I agree that I have read and will complete training with a qualifying resettlement agency located in Oregon and/or pay for a complete background check. I agree with the terms of this application and understand that any misrepresentation or omission of facts is cause for non-appointment to a volunteer position with the Portland Refugee Support Group. *

I have read and approve of the PRSG Volunteer Agreement.

Any comments? *

Full Name - Entering your name means that you’ve officially “signed” this form *

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