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Page 1 of 6 Mary’s Place Sexual Assault Center | P.O. Box 13954 | Savannah, GA 31416 | (912) 233-3000 | www.marysplacega.org Last updated – June 2022 Volunteer Application The purpose of the volunteer application is for the Mary’s Place (MP) Staff to learn more about you and to determine if this volunteer opportunity is a good match for your interests and skills. After submission and review of your application, an invitation to be formally interviewed and trained may follow. The interview does not guarantee acceptance into the volunteer program, however; after the initial interview, you will be notified if you have been accepted to participate in the MP volunteer training. If you are invited to attend our training course, the training will evaluate your performance during the training and make decisions accordingly. There are a limited number of volunteer positions available; unfortunately, everyone who applies cannot be accepted. Please note: Volunteer assignments with MP is not for a fixed term or definite period and may be terminated at the will of either party, with or without cause, and without prior notice. Application Date CONTACT INFORMATION Name Address City/State/Zip Code Phone Email Date of Birth/Age CRIMINAL BACKGROUND Have you ever been convicted of a misdemeanor or felony? YES NO If yes, please explain. ✔

Page 2 of 6 Mary’s Place Sexual Assault Center | P.O. Box 13954 | Savannah, GA 31416 | (912) 233-3000 | www.marysplacega.org Last updated – June 2022 EDUCATION AND CERTIFICATIONS Institution Area of Study Date of Completion/Graduation Institution Area of Study Date of Completion/Graduation Institution Area of Study Date of Completion/Graduation Institution Area of Study Date of Completion/Graduation Please list any additional training and/or certifications here. MILITARY EXPERIENCE Have you ever served in the armed forces of the United States? YES NO Were you honorably discharged? YES NO Branch Date of Service Date of Retirement/Discharge

Page 3 of 6 Mary’s Place Sexual Assault Center | P.O. Box 13954 | Savannah, GA 31416 | (912) 233-3000 | www.marysplacega.org Last updated – June 2022 EMPLOYMENT List your recent employment history (5 years). Attach additional copies if necessary. Employer Job Title City/State/Zip Code Start/End Date Duties & Responsibilities Employer Job Title City/State/Zip Code Start/End Date Duties & Responsibilities Employer Job Title City/State/Zip Code Start/End Date Duties & Responsibilities

Page 4 of 6 Mary’s Place Sexual Assault Center | P.O. Box 13954 | Savannah, GA 31416 | (912) 233-3000 | www.marysplacega.org Last updated – June 2022 VOLUNTEER EXPERIENCE List your recent volunteer experience. Agency Job Title City/State/Zip Code Supervisor/Coordinator Phone Number Start/End Date Duties & Responsibilities Reason for Leaving Agency Job Title City/State/Zip Code Supervisor/Coordinator Phone Number Start/End Date Duties & Responsibilities Reason for Leaving Agency Job Title City/State/Zip Code Supervisor/Coordinator Phone Number Start/End Date Duties & Responsibilities Reason for Leaving

Page 5 of 6 Mary’s Place Sexual Assault Center | P.O. Box 13954 | Savannah, GA 31416 | (912) 233-3000 | www.marysplacega.org Last updated – June 2022 MARY’S PLACE INQUIRIES Please answer each question honestly. 1. How did you learn about Mary’s Place? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2. Why do you want to work with survivors of rape and sexual assault as a Mary’s Place volunteer? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 3. What sexual assault training or experience working with sexual assault survivors have you received? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 4. What do you hope to gain from volunteering at Mary’s Place? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 5. Upon completion of training, will you be able to maintain a six-month commitment of two shifts per month? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 6. What days and hours will you be available for volunteer shifts? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 7. What are two of your strengths? In what two areas would you like to improve? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Page 6 of 6 Mary’s Place Sexual Assault Center | P.O. Box 13954 | Savannah, GA 31416 | (912) 233-3000 | www.marysplacega.org Last updated – June 2022 8. Describe your experience in working with diverse populations (ethnicity, gender, sexualorientation, religion, etc.).________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________9. Which volunteer role do you prefer – Crisis Help Line, Hospital Response, or both?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________AGREEMENT AND SIGNATURE By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal. I agree to complete a background check as required to serve as a Mary’s Place volunteer. _________________________ _________________________________ _________________ Printed Name Signature Date Thank you for completing this application and for your interest in volunteering with us!