Make-A-Wish Minnesota 615 First Avenue N.E., Suite 415 Minneapolis, MN 55413 612.767.9474 FAX: 612.767.2768 www.mn.wish.org info@wishmn.org Thank you very much for your interest in volunteering for Make-A Wish Minnesota! Becoming a volunteer is easy, just complete these steps: Volunteer Application Conflict of Interest Form: This form will be completed annually by all volunteers. Background Check Form: We ask all potential volunteers to complete a criminal background check. This is a mandatory part of our process and the information obtained will only be used for screening purposes. Background Check Fee of $30: To cover the cost of background checks, we ask all volunteers to contribute $30 along with their application. Please choose one of the following: I have included a check for $30 with this application (checks can be made out to Make-A-Wish Minnesota) I have completed the credit card payment form provided at the end of this application I have emailed/faxed my application and mailed a check for my $30 fee separately Volunteer Orientation: This can be completed at an upcoming orientation at our office or online. Contact our Volunteer Services Department (see contact info below) for more details. All application materials should be mailed, faxed, or scanned/emailed to: Make-A-Wish Minnesota Attn: Volunteer Services Department 615 1st Avenue NE, Suite 415 Minneapolis, MN 55413 fax: 612-767-2768 email: volunteerservices@wishmn.org
Thank you for your interest in volunteering with Make-A-Wish. Our volunteer program is designed to give each volunteer a diverse and rewarding experience while working towards fulfilling our mission to grant the wishes of children with life-threatening medical conditions to enrich the human experience with hope, strength and joy. HOW DO I BECOME A VOLUNTEER? In order to provide the wish children and their families with the best experience possible, we require all potential volunteers to go through an assessment before becoming an active Make-A- Wish volunteer. Volunteer paperwork takes 2-3 weeks to process and approve. After your paperwork is processed, you will be contacted with detailed instructions as it relates to the next steps based on the opportunities you selected. Please note that volunteer needs may vary by current chapter needs. WHY DO I NEED A BACKGROUND CHECK? Due to the nature of our work, official volunteer positions must successfully complete a criminal background check every 3 years. Make-A-Wish does not employ or utilize as a volunteer any individual who has been convicted of a crime that (a) victimizes children, (b) is sexual in nature, or (c) involves violence, fraud, or significant theft. Please contact us with any questions related to past convictions and/or our background check screening process. WHO DO I CONTACT WITH QUESTIONS? Our team is happy to answer any questions or address any concerns that you may have. Volunteer Services Department, (612) 767-9474 or volunteerservices@wishmn.org Make-A-Wish Minnesota (612) 767-9474 or www.mn.wish.org HOW DO I SUBMIT MY APPLICATION? Please complete and submit this packet to our office via fax, email or mail. Make-A-Wish Minnesota Attn: Volunteer Services Department 415 First Avenue NE, Suite 415 Minneapolis, MN 55413 volunteerservices@wishmn.org Fax: (612) 767-0242 PRIVACY & PROTECTION OF INFORMATION Security of information is extremely important to us. All information submitted is available to and accessed by only relevant personnel. Information is never sold or shared outside of Make-A-Wish.
Volunteer Application Please note that all volunteer opportunities require completion of this application and a signed Conflict of Interest and Ethics Statement and a criminal background check performed every three years. Volunteers are also required to successfully complete training relevant to the desired opportunity. Personal Information Title: Name: First Middle Last Nickname: Gender: Female Male Address: Street City State Zip County: Phone: Email: Home Cell Date of Birth: (mm/dd/yyyy) Preferred Phone: Home Cell Employment Information Employer: Address: Position: Street City State Zip Work Phone: May We Contact You at Work? Yes No Would your company be interested in becoming involved with Make-A-Wish? Yes No Emergency Contact Information Emergency Contact: Emergency Contact Phone: Relationship: Professional Skills Select those skills in which you have a professional capability and/or fluent. Construction / Carpentry, please specify: Entertainment Skills, please specify: Graphic Design / Art Design Interior Decorating Language, please specify: Photography Professional Certifications, please specify: Scrapbooking Writing Other:
Volunteer Opportunities Fundraising Assist development team in seeking in-kind donations, write grant and/or sponsorship proposals, collaborate to build partnerships with local companies, conduct research on local companies giving campaigns, organize a frequent flier donation campaign, sell paper Make-A-Wish stars, or plan/organize an external event to benefit Make-A-Wish. Office Assist with miscellaneous projects at the office, including phone calls, wish research, mailings, etc. Speaker s Bureau Speak at local community, school, business, or civic events increasing awareness and support for Make-A-Wish while educating audiences about the Make-A-Wish mission. Special Events Plan, organize, and implement successful fundraising events by working on event committees, helping out on the event day, and/or participating in the event. Translator Help facilitate wish experiences for non-english-speaking families. Translators have the option of becoming fully-trained wish granting volunteers, or they can provide short-term support on an as-needed basis. Wish Granting As a member of a wish team, wish granters meet with the family, help the wish child determine the wish and act as a liaison between Make-A-Wish staff and the wish family during the wish process. Wish granters must be a minimum of 18 years old. Attendance at an in-depth training session is required. In a few words, describe yourself and what motivated you to volunteer at this time in your life.
What are you looking to get out of this volunteer experience? How did you hear about Make-A-Wish? I affirm that the information I have given on this form is true and correct. The information that I have provided may be verified by contacting persons or organizations named in this application, or by contacting any person or organization that may have information concerning me, or by conducting a criminal background check. I have read and understood the various volunteer roles and am able to perform those roles in which I ve applied for. I am volunteering my time for personal reasons and understand I will not be paid for my services as a volunteer and I expect no compensation. Furthermore, I understand that this application will help in determining the best fit of my skills for Make-A-Wish. Signature: Date:
(Rev. 11/09/12) ANNUAL CONFLICT OF INTEREST AND ETHICS ASSURANCE STATEMENT As an employee or volunteer of the Make-A-Wish Foundation (the "Foundation"), I have an obligation to the Foundation and the constituencies it serves to comply with the highest standards of ethical conduct, including those set forth in the Foundation s Code of Ethics, Values and Conflict of Interest Policy. I will not commit acts contrary to those standards, and I will promptly report to appropriate Foundation t representatives either directly, or through MySafeWorkplace (a 24-hour confidential whistle-blower hotline that can be accessed at www.mysafeworkplace.com or by calling 1-800-461-9330) the commission of any such acts by others within the Foundation. I understand that my responsibilities include the following: Ethics and Legal Assurance _ I will at all times: (a) perform my duties in accordance with relevant laws, regulations and Foundation policies and standards; (b) promote the attainment of the Foundation's legitimate and ethical objectives; and (c) represent the interests of all constituencies served by the Foundation and not favor special interests inside or outside the Foundation in connection with Foundation business. I will refrain from: (a) violating any criminal or civil law or regulation, the violation of which may reflect poorly on the Foundation; and/or (b) engaging in or supporting any activity that would discredit the Foundation. I will submit to a criminal background check every three years (or more frequently if required by the Foundation), and I agree to disclose at the time I execute this document and thereafter as the same may arise any official investigations of criminal activities, arrests and/or convictions involving me (other than for routine traffic offenses not involving drugs or alcohol). Conflict Of Interest I will either avoid, or will promptly disclose and recuse myself from any decisions involving, any activity or practice which conflicts with, or can be perceived as conflicting with, the interests of the Foundation, including but not limited to situations where I, or a relative, friend or business acquaintance of mine, proposes to provide goods or services to the Foundation for consideration. I will refrain from using Foundation property or resources for personal profit or advantage, or for any purpose not related to the activities of the Foundation. I will refuse any personal gifts, loans, favors or other consideration of more than nominal value from any Foundation vendor, sponsor or other outside party that would influence, or could be perceived as influencing, my actions or the actions of others. Confidentiality During my involvement with the Foundation and thereafter, I will maintain the confidentiality of any information regarding the Foundation, wish children and their families, donors and volunteers that has not been released publicly, unless legally obligated to do otherwise. I will refrain from using or appearing to use confidential information acquired in the course of my service for unethical or illegal advantage, either personally or through third parties. I have read, understand and agree to be bound by the above standards. Print name Signature Date
Disclosure & Agreement IMPORTANT PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION Disclosure Regarding Background Investigation Make-A-Wish Foundation ( Company ) may obtain information about you from a third party consumer reporting agency in connection with your volunteer/employment application. Thus, you may be the subject of a consumer report and/or an investigative consumer report. These reports may contain information regarding your criminal history, social security verification, motor vehicle records ( driving records ), or credit history. Credit history will only be requested if such information is related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. The scope of this notice and authorization is allencompassing, allowing the Company to obtain from any outside organization all manners of consumer reports and investigative consumer reports now and throughout the course of your volunteer position/employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report. New York and Maine Applicants Only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified below directly. Acknowledgment and Authorization I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by the Company at any time after receipt of this authorization and throughout my volunteer employment. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by LexisNexis Screening Solutions Inc., P.O. Box 105108, Atlanta, GA 30348-5108, 1-800-845-6004, another outside organization acting on behalf of the Company itself. I agree that a facsimile ( fax ), electronic or photographic copy of this Authorization shall be as valid as the original. New York Applicants or Employees Only: By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law. Minnesota and Oklahoma Applicants or Employees Only: If you would like to receive a copy of a consumer report at no charge if one is obtained by the Company, you have a right to receive such a copy under state law. California Applicants or Employees Only: By signing below, you also acknowledge receipt of the notice regarding background investigations pursuant to California law. If you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company, you have a right to receive such a copy under California law. Last Name First Middle Signature Date 1
Consumer Information The following information is for identification purposes only. Please print clearly in black ink. Last Name First Middle List all other names used in the last 7 years Date of Birth Social Security Number Current Address City State Zip Phone Number Email Address History Please list the address, city, state and zip code where you have lived in the past 7 years with approximate dates. Address City State Zip Dates 2
Background Check Fee Credit Card Payment Volunteer s Name: Address: Zip: Phone: Date: Credit Card: Visa Master Discover AmExp Name on Card: Amount: $30.00 Signature: Expiration Date: Security Code (on back of card) Card #: