Volunteer Interest Form

Thank you for your interest in volunteering at Central City Concern! Please fill out the interest form below. After receiving your interest form, the Volunteer Manager will reach out to discuss next steps.

Questions about this form or volunteering at CCC? Contact volunteer@ccconcern.org

* Required

Title DR MISS MR MRS MS

First Name *

Last Name *

Pronouns

Email Address *

Cell Phone Number

What do you hope to gain from a volunteer experience at Central City Concern?

Have you ever been convicted of a crime? No Yes

If Yes, please list each conviction:

Volunteer Position(s) Interested In OTC Concierge OTRC Living Room Other

Are you available for a weekly or every other week commitment for at least three months? Yes No

Are you available between the hours of 8 am and 5 pm weekdays? Yes No

Have you received services from a Central City Concern healthcare program (Old Town Clinic, Old Town Recovery Center, CCC Recovery Center, Community Engagement Program, Hooper Detoxification Center, etc.) in the past two years? Yes No

Have you lived in Central City Concern housing at any point in the past two years? Yes No

Have you received any other CCC services or enrolled in any other CCC programs in the past two years? Yes No

If you answered yes to any of the above, please provide more details below such as dates and programs accessed.

I understand that to volunteer I must be willing to undergo a background check and that final clearance is based on passing the check. Yes No

Enter Word Verification in box below *

Prove you're not a robot *