Margaret Hudson Program, Inc. (MHP)
Volunteer Application of Interest
Please Select:
Date:
Volunteer
Intern
Social Security Number:
-
Name:
Female
(First)
(Middle)
Male
(Last)
Former Name(s) (maiden or other married names):
Address:
(Street Address)
(City)
Home Phone:
(State)
Date of Birth:
Cell Phone:
Employer:
(Zip)
Position:
Email Address:
Phone:
Contact Information in Case of Emergency:
Name:
Relationship:
(First)
(Last)
Home Phone:
Work Phone:
Cell Phone:
Name:
Relationship:
(First)
(Last)
Home Phone:
Education :
Work Phone:
9
10
11
12
Cell Phone:
College:
Degree:
List certificates, special trainings, etc:
List membership (organizations, groups, boards, etc):
Please check the campus location at which you are most interested in volunteering. Questions may be directed to: (918) 833-9874.
Tulsa Campus
1136 S. Allegheny Ave.
Tulsa, OK 74112
Broken Arrow Campus
751 West Knoxville
Broken Arrow, OK 74012
Please mark all areas of interest by order: First Selection (1)
Child Care Assistant (“Hugger”)
Second Selection (2)
Third Selection (3)
Request information on becoming a member of MHP Board of Directors
Mentor
Group Presentation on:
Alumni Network Committee
Higher Education\Career Options
Tutor - Subject
Health Issue(s)
Assist with Program Fundraisers
Social Issue(s)
Assist with or Sponsor Special Events
Self-Enrichment/Motivation
Other volunteer areas of interest:
Monday
Tuesday
Wednesday
Thursday
Volunteer duration (full school year, six months, etc):
Brief description of volunteer experiences?
Teaching Experience:
Yes
No
Fluent foreign language:
Would you rather work on your own, with a group or with a partner?
How did you hear about MHP?
What would you like to “get out of” volunteering for MHP? What would make you feel as if you have been successful?
Friday
References (Please list three people, other than relatives, who we can contact as personal references):
1.
2.
3.
Name
Name
Name
Street Address
Street Address
Street Address
City, State, Zip
City, State, Zip
City, State, Zip
Telephone
Telephone
Telephone
By law, a volunteer personnel file is maintained on each volunteer in the Margaret Hudson Program. Please be advised that it is the policy of The Margaret
Hudson Program to perform an Oklahoma State Bureau of Investigation (O.S.B.I.) Criminal History Background and Sex Offenders Registry Check on all
interested volunteers and personnel. The following information was obtained in order to complete the O.S.B.I. request form: full name including alias names,
race, sex, date of birth, and social security number. The Margaret Hudson Program does not discriminate on the basis of race, color, nationality, sex, sexual
orientation, age, familial status, parental status, education, religious beliefs, political beliefs, veteran status, or any other status protected by law. This
documentation becomes part of your personnel file, which is confidential and viewed only by the appropriate personnel, usually limited to the Administrative
Staff of The Margaret Hudson Program. If you have questions regarding this, or any other part of this application form, please contact the program Volunteer
Coordinator. Grounds for disqualification include:
● Refusal to submit to background screening
● Registered sex offender status
● Any felony offense
● Crimes against a child/minor
● Crimes involving the use of weapons
● Crimes involving arson
● Crimes involving public indecency
● Misdemeanors involving public indecency
● Misdemeanors involving DUI, DWI, or possession of any controlled substance within the last five years
● Other misdemeanors as the council may determine, including but not limited to theft, fraud, forgery
or traffic violations
The list of offenses not intended to be all-inclusive and in no way sets limits on the offenses that are deemed grounds for disqualifying an individual from
affiliation with MHP. Decisions on all other crimes or offenses not otherwise described above will be made at the sole discretion of the organization.
● Registered sex offenders are not eligible and may not participate in any capacity with The Margaret Hudson Program. Volunteers shall not knowingly
recruit and/or involve clients of MHP with registered sex offenders.
● It is the duty of every volunteer within ten (10) days of an offence to notify MHP in writing.
The information that I have provided on this application is true and complete to the best of my knowledge. I understand that any misrepresentation or
omission of fact is grounds for discharge. It is understood that I am offering my services to the Margaret Hudson Program without compensation and
without any rights to health insurance or other benefits. I further understand that in signing this form I give my permission for MHP personnel to contact
references given and to perform above reference checks.
Signed:
Dated:
As a nonprofit organization, MHP asks volunteers to consider a donation of $28.00 to cover the cost of the OSBI. If you are unable to give the full amount,
please consider a donation in any amount. However, under no circumstances will we reject a qualified volunteer if they are unable to make the donation
and MHP will cover the cost under those circumstances. Interns are responsible for the cost.
Please select one of the following:
I have included a payment in the amount of $28.00 for the cost of the OSBI.
I am unable to pay the full cost of the OSBI. I included a partial payment in the amount of $
I am unable to make a financial contribution at this time.
Method of Payment:
Check
Credit Card
Cash
You contribution may be tax deductible by law.
Please return completed application to:
Volunteer Coordinator- Adrenna Wells
Margaret Hudson Program, Inc.
1136 S. Allegheny Ave.
Tulsa, OK 74112
Telephone: (918) 833-9874
Email:
For Office Use:
Baby Steps Tour Completion Date:
O.S.B.I Cleared:
References Checked:
Volunteer Orientation Completion Date:
Date Completed Application Received:
Volunteer Coordinator Signature:
Start Date
Amount Enclosed:
Payment Type: [] Check [] Cash [] Money Order
Campus