Volunteer Crisis Advocate Application

Before completing this application, please read the Volunteer Crisis Advocate Handbook and review all training dates and times. If you have questions, please contact Director of Crisis Services Graham Daniels by calling 540-345-7273 or email: gdaniels@sararoanoke.org.

VCA Application

Full Name*
First Middle Last
Preferred Name/Nickname
Pronouns
Date of Birth*
MM slash DD slash YYYY
Permanent Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address (if different that above)
Street Address Address Line 2 City State ZIP Code
Primary Phone*
Phone Number Type*
- Cell Phone
- Home Phone
Primary Email Address*
Are you seeking internship credit?*
If yes, how many total hours are required for your internship?
Occupation/College Student Year
Employer or College/University
Name of Work Supervisor/Internship Supervisor
First Last
Supervisor Email Address
Supervisor Phone Number
Have you read the Volunteer Crisis Advocate Handbook completely?*
Have you reviewed all training dates listed on the website?*
Please list any scheduling conflicts you have during the training dates listed.
Do you have reliable transportation?*
Do you have a smartphone?*
What is your typical availability for on call during the week? Please check all that apply.*
- Weekdays (7 am - 7 pm)
- Weeknights (7 pm - 7 am)
- Weekends (Saturday and Sunday)
Are you able to commit to at least one (1) year of service to the VCA Program at SARA Roanoke?*
Are you able to attend monthly Volunteer Crisis Advocate meetings?*
Are you able to respond to Carilion Roanoke Memorial Hospital within one (1) hour?*
Have you ever been convicted of a crime?*
If you answered yes, please explain:
Are you willing to submit to a background check?*
Do you speak any languages other than English?*
If yes, please tell us what other languages you speak:
Please share any special accommodations (including dietary restrictions) you require:
What is your t-shirt (unisex) size?*
How did you learn about the Volunteer Crisis Advocate program at SARA?*
Please tell us what made you decide to become a Volunteer Crisis Advocate at this time.*
Tell us about your past and/or current volunteer experience.*
Reference 1 Name*
First Last
Please do not list family members. Professional references are preferred.
Reference 1: Relationship to You*
Reference 1 Email Address*
Reference 1 Phone Number*
Reference 1: How long have you known this person?*
Reference 2 Name*
First Last
Please do not list family members. Professional references are preferred.
Reference 2: Relationship to You*
Reference 2 Email Address*
Reference 2 Phone Number*
Reference 2: How long have you known this person?*
Acknowledgment*
I understand and acknowledge the information in this application is true and complete to the best of my ability. I understand my references and employer may be contacted to provide additional information necessary in the approval of my application. I understand that all information included in this application will be used for screening purposes only and will not be shared with any entities outside of SARA Roanoke.