MHA of Central Carolinas


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Interested in becoming a MHA volunteer? Review current opportunities on our Volunteer Options page, select opportunities matching your interest(s) and availability, and complete and submit the Volunteer application below. Together, we are making a difference!

General Information
Name:
Date of Birth:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Mobile:
Email Address:
Employer:
Occupation:
Education:
Do you have access to transportation?	Yes No
Previous volunteer experience:
Special skills you’d like to share as a volunteer:
Do you have any current medical or psychological conditions or physical limitations which would affect your volunteer work? If so, please describe	Yes No
How did you learn about MHA?
Availability to volunteer (Day/time/frequency)

Emergency Contact Information
Name:
Relationship:
Address:
City:
State:
Zip Code:
Phone (Day):
Phone (Evening):
Have you ever been convicted of a crime (except minor traffic violations)?	Yes No
If Yes, Describe nature of the crime, date of charge, and disposition:
Are there any misdemeanor/felony charges pending against you currently?	Yes No
If Yes, Describe nature of charge:

I certify that the above information is accurate and I give the MHA my permission to verify this information with the appropriate agencies.
Volunteer’s Name:
Date:

Volunteer Confidentiality Agreement
Please initial each statement below:
	It is my understanding that all information I provide to MHA is true and complete to the best of my knowledge, and will be kept in confidence by the Mental Health Association of Central Carolinas, Inc. I understand that giving false information may be cause for immediate dismissal.
	I will maintain complete confidentiality concerning all MHA consumer or donor information I may come into contact with as a volunteer.


	Compeer Volunteer Application compeerVolunteerApplication.pdf