Illinois Gender Advocates
Trans Youth Resource and Advocacy Project

Youth Leadership Volunteer Form

The information contained on this sheet is strictly for use by the Volunteer Coordinator,
and shall not be used for any other purpose.

CONTACT INFORMATION

Name: _____________________________________________________________________________

Home Address: ______________________________________________________________________

City: ________________________________________ State: ____________ ZIP Code: _____________

Home Telephone: _________________________Work Telephone: ______________________________

Mobile Telephone: ________________________ E-mail Address: _______________________________

We will need to contact you by telephone. Please provide the following information regarding telephone contacts:

_____ You may call me at home. Please ask for me (or leave a message for me) using the following name (if different from above): _____________________________________
_____ Please do NOT call me at home.

_____ You may call me at work. Please ask for me (or leave a message for me) using the following name (if different from above): _____________________________________
_____ Please do NOT call me at work.

_____ You may call me on my mobile phone. _____Please do NOT call me on my mobile phone.

PERSONAL INFORMATION (Check all that apply)

I have the following special talents, skills, education, and/or training that may be useful in my volunteer work: ________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

I have the following limitations and/or disabilities that may limit the scope or extent of my volunteer activities:_________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Please note: All volunteers who will be working with youth at the TYRA drop in center will need to complete a training unless they have previous experience working with GLBT Youth Drop-In programs.
All volunteers are subject to approval following a background check by Illinois Department of Children & Family Services (DCFS), Child Abuse and Neglect Tracking System (CANTS).

Please check all that apply:
I have experience or have been trained to work with GLBT Youth     Yes________                 No________
If you answered "yes" to the above question, where and when? ____________________________________
I agree to participate in the TYRA Volunteer training program:           Yes________                 No________
I agree to a background check by the Illinois DCFS.   Check one        Yes________                 No________