Volunteer Advocate Application

Victim Advocate Application

Wichita Area Sexual Assault Center works with individuals and communities through comprehensive services to create a culture of intolerance for sexual violence and an atmosphere of healing for those impacted by it.

Applicant Name
Name *

First

Middle

Last
Please list all other names previously used
Name

First

Middle

Last
Name

First

Middle

Last
Name

First

Middle

Last
Contact Information
Preferred Phone Number(s) *
Email Address *
Home Address
Street *
City *
State *
Zip *
Number of years at current address *
Mailing Address

If different than above.
Street
City
State
Zip
Employment and School Information
Employer name
Position held
Are you currently a student? *
College attending/attended
Degree, if any
Year
Are you willing to make a minimum of a one year commitment to WASAC? *
Please list any special education or training that would help you as a WASAC volunteer.
Please list community or board affiliation(s).
How did you learn about WASAC? *
Have you ever been convicted of a crime? *
Emergency Contact Form
Name *

First

Last
Relationship to you *
Phone *
References

Please list two professional and one character reference (other than family members)
Reference 1 - Name, Relationship, Years Known, Phone Number *
Reference 2 - Name, Relationship, Years Known, Phone Number *
Reference 3 - Name, Relationship, Years Known, Phone Number *

Victim Advocate Application

Applicant Name

Please list all other names previously used

Contact Information

Home Address

Mailing Address

Employment and School Information

Emergency Contact Form

References