Volunteer Social or Support Group Facilitator Application

Legal Name *
Legal Name
Legal name required for purposes of confidential background check. Your legal name will not be shared (without your written permission) except where required by law.
Preferred Name *
Preferred Name
Your preferred name is how you will be referred to in all correspondence and while volunteering with GRPC.
Phone Number *
Phone Number
Birth Date *
Birth Date
This is required for background check. Facilitators must be at least 21 years of age.
Legal Sex required for purpose of confidential background check. Your legal sex will not be shared or used without your written permission except where required by law.
If your pronoun was not listed, please tell us.
Being fluent means: able to speak or write a particular language easily and accurately.
Reference 1 Phone Number *
Reference 1 Phone Number
Reference 2 Phone Number *
Reference 2 Phone Number
Please list your last 3 employers or internships.
Dates Employed
Dates Employed
Please list your last 3 employers or internships.
Dates Employed
Dates Employed
Please list your last 3 employers or internships.
Dates Employed
Dates Employed
Which group(s) are you interested in facilitating?
Please check all that apply. Please note that except for our Youth, Young Adult and LGBT+ME groups, you must identify as the target audience for that group. Ie: Facilitator's for Own Your Gender, must identify as Transgender or Gender Non-Conforming.
I hereby authorize Grand Rapids Pride Center (GRPC) bearing a copy of this release, at anytime during my participation as a volunteer to run a background check. I understand that at a minimum the GRPC will run the background check once a calendar year. GRPC may obtain any information pertaining to my criminal history from local, state, or federal agencies as necessary to ensure the safety of of GRPC, it's staff or others in the community. This release is executed with the full knowledge and understanding that the information is for the official use of GRPC. Consent is granted for GRPC to furnish such information, as directed above to third parties in the course of fulfilling its official responsibilities. I hereby release GRPC and any agencies needed to obtain this information from any and all liability for damages of whatever kind, which may at the time result to me, my heirs, family, or associates because of my compliance with this authorization and request to release information, or any attempt to comply with it.
I certify that all of the above information is true and correct.