Host Application for Hattie's House
Hattie's House volunteer application form to host San Diego area patients and families in need
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Email *
Full Name *
Phone Number *
Phone Type *
Preferred Method Of Contact *
Address Information *
Street
City *
State *
Zip *
How did you find out about us ? ( please be specific as possible *
Why are you interested in volunteering with Hattie's House *
Please provide a description of the space you have available in your home to potentially host a Hattie's House guest *
Person 1 Relationship to Main Contact *
Would Person 1 be actively involved in hosting? *
Person 2 Name *
Person 2 relationship to Main Contact *
Would person 2 be actively involved in hosting? *
If there are additional household members, please provide the same information for any additional household occupants: *
Occupation(s) of adult(s) in household *
Employer(s) of adult(s) in household *
Main Contact Work Schedule *
Work schedule of other adult(s) who be be actively involved in hosting ( if applicable) *
If "other" or you would like to provide additional information about your schedule describe here: *
High School(s) attended
College(s) attended:
Please briefly describe your volunteer experiences, in any, including organization and role. *
Have you every hosted individuals or families in your home before? If so, please provide a short description of the program and your involvement. *
Do you speak any languages beside English? If so, which languages and to what proficiency? *
Have you ever been convicted of a felony? *
If Yes, please give date(s) and explain *
Have any household members ever been convicted of a misdemeanor, besides traffic violations? *
If Yes please give date(s) and explain *
Acknowledgement and Certification                         I hereby certify, by typing my name in the box provided below, that the information that I have provided on this application is truthful, complete, and accurate to the best of my knowledge.I acknowledge that completing this application does not form a contract between myself and the Hattie’s House and does not guaranteed that I will be excepted for participation in the program.
Electronic Signature *
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