First and Last Name

Phone Number (Enter in the format XXXXXXXXXX)

Email Address

Mailing Address

I prefer to be contacted by: I prefer to be contacted by: Email Phonecall Text

Can you commit to volunteer for at least 3 months? Can you commit to volunteer for at least 3 months? Yes No

Why are you interested in volunteering with the Match Program?

Do you have previous experience working with other cultures? If yes, please explain.

As a volunteer, IMAA wants to acknowledge our appreciation for your time and commitment. How do you like to be thanked as a volunteer?

Receipt and Knowledge of IMAA Match Program Guidelines and Background Check 1) In accordance with Federal Law and IMAA policy, this institution is prohibited from discrimination on the basis of race, color, creed, religion, national origin, ancestry, disability, age, marital status, sex, sexual orientation, status with regard to public assistance, citizenship status, national origin, or any other protected class status. I understand this non-discrimination policy and agree to abide by it. 2) I also agree to be nonjudgmental and respectful of IMAA clients. I understand that IMAA’s mission is to empower people of all languages and cultures to become self-reliant. I will do my best to further that mission. 3) All information about clients, volunteers, donors, and employees of IMAA is confidential and may not be discussed outside the building, or with any unauthorized person. This includes the identity of people utilizing IMAA’s services and programs, as well as any information about those people. 4) I understand this and understand that the Minnesota Data Practices Act and the Federal Health Insurance Portability and Accountability Act (HIPAA) provides for the protection of private and confidential data and that any violation of those laws, including improper disclosure of private or confidential data to which I may have access, may result in civil or criminal penalties. 5) I will abide by all other policies and procedures of IMAA. I have received and read a copy of the IMAA Match Program Volunteer Guidelines. I understand that a background check will be conducted, and I give permission to IMAA to review my personal history as recorded by the State Bureau of Criminal Apprehension and any other sources available. I further understand that, by signing this statement, I am indicating that I have read the Volunteer Guidelines and understand the contents, and have discussed questions I have with the Volunteer Coordinator. I also realize that this statement will become a permanent part of my volunteer personnel file.

I have read and understand the terms of the volunteer agreement and guidelines and agree to a background check. I have read and understand the terms of the volunteer agreement and guidelines and agree to a background check. Yes No

Signature (typing your first and last name will be your signature)

Today's Date

Date of Birth

Additional Questions or comments