Volunteer Information Sheet

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Date of Birth *

Volunteer Status *

Volunteer

Court Ordered

Availability

Days Available *

Shift preference: *

Please indicate the types of volunteer services you can provide. *

Maintaining an individual’s confidentially and dignity is of the utmost importance at GS NOVA. Records
are kept on any individual or family requesting our services. The staff and volunteers will consider all
information gathered about an individual as private and confidential. All records are the property of
GS NOVA.

Confidentiality will be maintained by the following guidelines:
• No information will be made public knowledge without written consent of GS Nova.
• Volunteers are not to get involved in the lives of guests. We offer an intensive case
management program. If you have questions, please call the GS Nova office.
• Please do not return to the shelter without permission of the GS Nova office.
• Volunteers or children of volunteers CAN NOT enter ANY guest’s rooms.
• We request that you do not bring any donations or gifts directly to the shelter. If there are
items that you would like to donate, please bring them to the main offices located at 20684
Ashburn Road, Ashburn Va. 20147.
• You may not give out telephone numbers of any staff member and or guests.
• Violation of Confidentiality Policies is immediate grounds for dismissal of volunteer services.

I have read and understand the Confidentiality Policy of GS Nova.

Signature *

clear

Date * +