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SJCCF Volunteer Application
 

SJCCF Volunteer Application

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Stevie JoEllie's Cancer Care Fund Volunteer Application

Stevie JoEllie's Cancer Care Fund Volunteer Application

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    SJCCF Volunteer Application SJCCF Volunteer Application Document Transcript

    • Stevie JoEllie’s Cancer Care Fund Volunteer Application Stevie JoEllies Cancer Care Fund is a 100% Volunteer led thyroid cancer awareness, access to care and free supportive services project of United Page | 1 Charitable Programs Inc., a 501(c) 3 Public Charity. All donations and gifts- in-kind-contributions are tax deductible as allowed by law. All funds raised by Stevie JoEllies Cancer Care Fund are received by United Charitable Programs and become the sole property of UCP which, for internal purposes, allocates funds to "project".Stevie JoEllies Cancer Care Funds project manager and/or executive director (Founder WilmaColon-Ariza) makes recommendations for disbursements which are reviewed by UCP for approvalaccording to federal and state tax exempt laws.Our Mission is one of caring. Our goal is to help relieve the financial burden placed upon theindividual and family living "with" thyroid cancer. Our hope lives with the millions of peopleworldwide who look towards a day when research will unlock the doors of sound effectiveprevention and a cure for all cancers. Until that day comes, we press forward to assist those forwhom research is too late. We hope you will join us!About Thyroid CancerThe American Cancer Institute projects there will be 48,000 new cases of thyroid cancer diagnosedthis year (2011), and 1750 deaths. It is the fastest increasing newly diagnosed cancer worldwideregardless of age, sex, race or ethnic background. Women are three times more likely than men tobe diagnosed with thyroid cancer making it the 4th most common cancer among womennationwide. In addition childhood cancer survivors are also at an increased risk of developing thecondition later in life.The thyroid is a butterfly shaped gland located at the lower front of the neck. Papillary is the mostcommon thyroid cancer and strikes mostly women of child bearing age. Medullary thyroid cancerdevelops in the C cells, which make hormones that help maintain healthy calcium levels in theblood. The thyroid also produces hormones that regulate body temperature, weight, blood pressureand heart rate. Medullary cancer is usually hereditary. Follicular thyroid cancer develops in thefollicular areas and is fast growing and likely to spread. A rare and deadly form of thyroid cancer iscalled Anaplastic.Thyroid cancer symptoms include a lump in the front of the neck, recurring or constant pain in thethroat or neck, swollen lymph nodes in the neck, trouble breathing or swallowing and hoarsenessor voice changes. Many of these symptoms can also be caused by benign conditions like goiter orinfection.Learn More Visit Our Bloghttp://sjccfthynet.blogspot.com Stevie JoEllie’s Cancer Care Fund is a project of United Charitable Programs Inc., a Registered 501 ( c ) 3 Public Charity
    • Stevie JoEllie’s Cancer Care Fund Volunteer ApplicationOur organization encourages the participation of volunteers who support our mission, vision and goals asset forth in our volunteer application introduction. We encourage you to complete our volunteer application.Stevie JoEllie’s Cancer Care Fund will train you in our internal policies and procedures, and often offersadditional opportunities to participate in “other” free training sessions to better serve our community. Ourobjective is to hire from within our pool of trained and dedicated volunteers. All volunteer and employee Page | 2application information is kept confidential and will help us find the most satisfying and appropriate volunteeror employment opportunity for you within our organization. Thank you for your interest in our organization.Please PrintFirst Name..................................................................... …….Last Name………………………………………..………….…Address……………………………..…………………….............City…………………………………State………Zip…………Telephone………………………………………………………….Mobile…………………………………………..……………..Date of Birth .................................................................. ……..Social Security #..............................................................Gender (Please Circle One) Male Female TransgenderedPhysical Limitations No Yes (Please Explain)…………………………………………………………………………………………………………………………………………………………………………………………………….Languages Fluent Read Write1 ....................................................................................... 2. ........................................................................................3 ....................................................................................... 4 .. ……………………………………………………………….Education (highest level completed)Grades 1-5 6-9 11-12 College Business Graduate School Technical/VocationalIn an emergency, notify:First Name........................................................... Last Name .......................................................................................Address ............................................................... ........................................................................................................City/State/Zip....................................................... Telephone .......................................................................................Please list current and/or previous volunteer work including brief description of duties, activities and dates ofservice if applicable.………………………………………………………………………………………………………………………………………..…………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………..…………………………………………………………………………………………………………………………………………. Stevie JoEllie’s Cancer Care Fund is a project of United Charitable Programs Inc., a Registered 501 ( c ) 3 Public Charity
    • Stevie JoEllie’s Cancer Care Fund Volunteer ApplicationCurrently Employed by ……….………………………………………………………………………………………………….…..Address……………………………..…………………….............City…………………………………State………Zip……….…Telephone…………………………………………………..May we contact you at work?...................................................... Page | 3Brief Description of Work /Position……………………………………………………………………………………………….....…………………………………………………………………………………………………………………………………….….……………………………………………………………………………………………………………………………………………..Skills (List your skills and indicate proficiency level) Skilled Can Teach Amateur1. ...................................................................................... ...........................................................................................2 ....................................................................................... ...........................................................................................3 ....................................................................................... ...........................................................................................4…………………………………………………………………………………………………………………………...............Volunteer availability: (Circle all applicable)Number of Days per week: 1 2 3 4 5 Hours per Week: 4 6 8 10 12 14 16 18 20Monday Tuesday Wednesday Thursday Friday Saturday Sunday No PreferenceTransportation: How you will get to your assignment? Please circle all that applyPublic Trans. Walk Bus/Van Taxi/Car Svc Car Virtual Assistant Online OtherHow did you learn about our organization? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………..Why do you want to volunteer for our organization? ....................................................................................................…………………………………………………………………………………………………………………………………………..Have you ever been convicted of a crime other than a traffic violation? No Yes PendingCharge:……………………………………………….Conviction Date(s)………………………………….. State……………….Would you consent to a routine background check? (Circle One) Yes NoPlease list 3 Personal References of people who know you well other than relatives, preferably people for whom youhave worked in either a paid or volunteer capacity in the past 24 months.1………………………………………………………….Relationship ……………………………………Tel……………………2………………………………………………………….Relationship ……………………………………Tel……………………3 ………………………………………………………….Relationship ……………………………………Tel…………………… Stevie JoEllie’s Cancer Care Fund is a project of United Charitable Programs Inc., a Registered 501 ( c ) 3 Public Charity
    • Stevie JoEllie’s Cancer Care Fund Volunteer ApplicationVolunteer hereby agrees to serve any client who is assigned regardless of race, sex, creed or nationalorigin. As a volunteer of Stevie JoEllie’s Cancer Care Fund I agree to abide by the governing rules, policies Page | 4and procedures of the organization. I understand that I will be volunteering at my own risk and that SJCCFemployees, and affiliates, cannot assume any responsibility or liability for any accident, injury or healthproblem that arises from any of my volunteer work/service I perform for the organization. I agree that all thework and/or service I will perform on behalf of the Stevie JoEllie’s Cancer Care Fund will be on a volunteerbasis and I am not eligible to receive any monetary compensation.......................................................................................... ........................................................................................... (Signature/Volunteer) (Date)……………………………………………………………………………………………………………………………………... (Printed Name) Please Email Completed Application to sjccfthynet@gmail.com Mail To: Stevie JoEllie’s Cancer Care Fund c/o Wilma Ariza, Founder 649 McBride Avenue Apt 1 Woodland Park, NJ 07424 Stevie JoEllie’s Cancer Care Fund is a project of United Charitable Programs Inc., a Registered 501 ( c ) 3 Public Charity