Sign Up to Volunteer - LightHouse for the Blind and Visually Impaired

Contact Information

First Name ^*

Nickname

Last Name ^*

Personal Pronoun (Ex: He, She, They, etc.)

Email ^*

Primary Phone ^*

Primary Phone Type ^*

Street Address ^*

City ^*

State ^*

Zip ^*

Country ^*

How did you hear about LightHouse?

Employer/ School Name (if not applicable, write N/A) ^*

Title (if not applicable, write N/A) ^*

Birthdate (mm/dd/yyyy) ^*

Emergency Contact Name ^*

Emergency Contact Relationship ^*

Emergency Contact Phone ^*

Volunteer Information

Do you have any accommodation needs or requests to make volunteering at LightHouse more accessible to you? (Examples include, screen reader software, cannot stand for long periods of time, chemical sensitivities, etc.) ^*

Would you be willing to provide professional and/or personal references upon request? ^*

Groups, Clubs and Affiliations: Please list any groups or clubs you may be affiliated with while volunteering.

Certifications (examples, CPR, Lifeguard, RN, etc.)

Describe any previous volunteer experience. ^*

Why do you want to volunteer at LightHouse? ^*

Describe any experience engaging with individuals who are blind or have low vision. ^*

Volunteer Preferences

Check below to indicate the type(s) of volunteer opportunities you are interested in.

Personal Service Volunteer

Fitness Partner

LightHouse Agency Volunteer

Event Volunteer

Enchanted Hills Napa Volunteer

NOTE: For the next few questions, please select all options that apply by using ctr/cmd+click. If you encounter any technical difficulties, please use the text box provided at the end of this section to type in your responses.

What languages do you speak fluently or near fluently? Please select all applicable (ctrl/cmd + click).

Distance Willing to Travel: Please select all areas you are willing to travel (ctr/cmd+click). This is especially important for those interested in becoming a Personal Services Volunteer (PSV) and/or Fitness Partner. ^*

Anything additional you would like us to know about you?

Demographic Information

This information is collected so that we know who represents our volunteer team. We are committed to diversity and equity and hope that our volunteers reflect the diversity and strengths of the LightHouse community. This information remains confidential and is used and collected for yearly reporting purposes only. If you choose not to disclose any of this information, please select “Declined” from among the Drop-down options.

Gender ^*

Do you have a disability?* ^*

What is your level of hearing? ^*

What is your level of vision?** ^*

Are you a veteran?*** ^*

* Under the ADA Amendments Act of 2008, a disability is defined as: (1) a physical or mental impairment that substantially limits a major life activity; or (2) a record of a physical or mental impairment that substantially limited a major life activity; or (3) an actual or perceived impairment.

** Legal blindness is a level of vision loss that has been legally defined to determine eligibility for benefits. The clinical diagnosis refers to a central visual acuity of 20/200 or less in the better eye with the best possible correction, and/or a visual field of 20 degrees or less.

*** A veteran is a person who served in the active military, naval, or air service, and who was discharged or released there from conditions other than dishonorable.