Date ________________________

Name___________________________________________________________Birthdate_________

Address__________________________________________________________________________
__________________________________________________________________Zip___________
Home Phone_____________________________Bus. Phone________________________________
Occupation_______________________________________________________________________
Employer________________________________________________________________________
Marital Status: Single_____ Married______ Separated _______ Divorced_______ Widowed ________
Spouse’s Name____________________________________________________________________
Spouse’s Occupation________________________________________________________________
Children: Name__________________________ Age__________
Name__________________________Age___________
Name__________________________Age___________

Will you be needing childcare?___________________

In which area would you like to volunteer?______________________________________________
High School Attended_____________________________________________________________
Graduate? Yes___ No___ What Year?____
College Attended_________________________________________________________________
Graduate? Yes___ No___ What Year?____
Special Qualifications (advanced degree, counseling experience, etc.)___________________________
_______________________________________________________________________________

_______________________________________________________________________________
Field of working experience__________________________________________________________
_______________________________________________________________________________
Previous volunteer experience________________________________________________________
_______________________________________________________________________________
Have you ever volunteered in a crisis pregnancy center before?_________________________________

Where?______________________________________
Have you had other experiences or training that would be of value to you in helping people with problem pregnancies?______________________________________________________________________
_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________
What are your strengths, gifts/talents and how could they benefit this ministry? _____________________
________________________________________________________________________________
________________________________________________________________________________
Why would you like to be a DPC Volunteer?______________________________________________
________________________________________________________________________________
________________________________________________________________________________
How does your family/spouse feel about this kind of work?___________________________________
________________________________________________________________________________
Have you ever counseled a man or woman who was experiencing an unplanned pregnancy ? If so, please

describe circumstances and the outcome & if not, how would you counsel them?____________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Have you personally had experiences related to abortion? If so, please explain circumstances.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
If you are post-abortive, have you received post-abortion counseling? If so, what type of

counseling (professional, group?)_______________________________________________________
________________________________________________________________________________
Please explain your personal stand on abortion. ____________________________________________
________________________________________________________________________________
Are there any circumstances in which you would consider abortion as an alternative? ________________ ________________________________________________________________________________
Are you familiar with abortion procedures? _______________________________________________
Do you have knowledge about laws governing abortion? _____________________________________
What is your understanding of what the Bible teaches concerning abortion? _______________________
________________________________________________________________________________
Please state your opinion on birth control for unmarried men and women?________________________

________________________________________________________________________________
Have you previously been under the care of a counselor or psychiatrist? If yes, please explain._________
________________________________________________________________________________
Are you presently or have you been under any legal investigation for any reason or ever been convicted of a crime? If so, please explain _________________________________________________________
_______________________________________________________________________________
Are there any personalities/socio-economic backgrounds that you might have difficulty working with?
________________________________________________________________________________
In your own words, what is counseling?__________________________________________________
________________________________________________________________________________
Why do you believe you are capable of effectively working with a woman in a crisis?________________
________________________________________________________________________________
If selected as a counselor, are you willing to consistently give the DPC a priority commitment?__________
Are you willing to attend all of the DPC training sessions?_____________________________________
Please list the names, (preferably EMAIL) addresses and phone numbers of 3 personal references that we may contact.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
How do you know that you are a Christian?_______________________________________________
________________________________________________________________________________
Briefly share your testimony. __________________________________________________________
________________________________________________________________________________
Name of church you attend.___________________________________________________________
Pastor’s Name.____________________________________________________________________
Describe your volunteer positions held or involvement with your church. __________________________
________________________________________________________________________________
What is your attitude about sharing your personal faith in Jesus Christ?___________________________
________________________________________________________________________________
Have you ever received training to share your faith in Jesus Christ?__________ When, where and type of program._________________________________________________________________________
If no, are you willing to be trained in personal evangelism?____________________________________