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Volunteer Application
Volunteer Opportunities
Nevada Community Prevention Coalition Inc. (NvCPC) has several opportunities for giving back and supporting your community. We will match your goals and experience to a relevant volunteer opportunity in a local school, senior center, or community center where you will have the best opportunity to give back and support your local community. We also offer opportunites where you can serve to earn credit towards graduation or to build your experience and resume.
We appreciate your consideration and support.
Choose Your Community
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15N Mesquite
15N Bunkerville
15N Moapa
15N Riverside
15N Glendale
15N Logandale
15N Overton
15N Moapa Reservation
15N Crystal
15N Cottonwood
95N Indian Springs
95N Cold Creek
95N Corn Creek
160W Blue Diamond
160W Mountain Springs
95S Boulder City
95S Nelson
95S Searchlight
95S CalNevAri
95S Laughlin
95S Mojave Reservation
15S Jean
15S Good Springs
15S Sandy Valley
15S Primm
Choose Your Discipline
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Administration
Advertising Media
Board Member
DFC Committee
Finance
Mentor
Outreach Team
Policy Committee
Program Support
Social Media
Web Production
Choose Your Role
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Adult Mentor - age 21 up
Adult Mentor - age 18-20
Peer Mentor - age 13-17
Adult Volunteer - age 18 up
Youth Volunteer - age 13-17
Personal Information
First Name
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Last Name
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Street Address
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Mailing Address (if different)
City
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State
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Arizona
California
Nevada
Utah
Zip Code
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Phone Number
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Email Address
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Date of Birth
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Drivers License or State Issued ID Number
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State Issued
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Arizona
California
Nevada
Utah
Other
Tell us in your words what you would like to volunteer for.
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0/50 words
Tell us in your words WHY you want to volunteer
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0/50 words
Personal Information Part 2
Select One that describes YOU!
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MINOR age 11-17 (parent approval required)
YOUNG ADULT age 18-24
ADULT age 25-34
ADULT age 35-54
SENIOR age 55+
Select two (2) that BEST describe YOU!
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Student
Active Military
Business Owner
Educator
Elected Official
First Responder
Grandparent
Health Care Worker
In Recovery
Media Professional
Mentor
Parent
Primary Caregiver
Veteran
Volunteer
Parental / Legal Guardian Minor Volunteer Authorization
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I am the parent / legal guardian of the Minor Volunteer Applicant listed on the Volunteer Application and I provide consent for above listed Minor Volunteer Applicant to participate in NvCPC volunteer activities, supervised by an NvCPC contracted or full-time staff member, within the legal limits of all applicable laws.
This section to be completed by Parent or Legal Guardian of Minor Volunteer Applicant:
First Name
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Last Name
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Street Address
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Address Line 2
City
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State
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Arizona
California
Nevada
Utah
Zip Code
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Phone Number
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Email Address
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Drivers License or State Issued ID Number
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State Issued
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Arizona
California
Nevada
Utah
Other
Community Impact Survey Part 1 of 3
Please select and rank 10 out of the following 19 options below. Choose the risk factor that you feel most negatively impacts your community and mark it with a 1. Then mark the second highest risk factor and mark it with a 2. Continue this process until reaching 10.
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COM01 Availability of Drugs
COM03 Community Laws and Norms favorable toward drug use and crime
COM04 Media Portrayals of Violence
COM05 Transitions and Mobility
COM06 Low Neighborhood Attachment and Community Disorganization
COM07 Extreme Economic Deprivation
FAM01 Family History of the Problem Behavior
FAM02 Family Management Problems
FAM03 Family Conflict
FAM04 Favorable Parental Attitudes and Involvement in the Problem Behavior
IND01 Early and Persistent Antisocial Behavior
IND02 Rebelliousness
IND03 Friends who Engage in the Problem Behavior
IND04 Gang Involvement
IND05 Favorable Attitudes Toward the Problem Behavior
IND06 Early Initiation of the Problem Behavior
IND07 Constitutional Factors
SCH01 Academic Failure Beginning in Late Elementary School
SCH02 Lack of Commitment to School
Community Impact Survey Part 2 of 3
Please select and rank 5 of the following 15 options below. Choose the strategy you believe would have the strongest positive impact on your community and mark it with a 1. Then mark the second with a 2. Continue this process until reaching 5.
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TPR01 Strong Bonds with Family
TPR02 Expectation of Parental Monitoring with Clear Rules of Conduct with Family
TPR03 Success in School Performance
TPR04 Strong Bonds with Pro-Social institutions (Family / Church / School)
TPR05 Adoptions of Conventional Norms About Drug Use
TPR06 Skill Building
TPR07 Problem Solving
TPR09 Empowerment
TPR10 Boundaries and Expectations
TPR11 Constructive Use of Time
TPR12 Commitment to Learning
TPR13 Positive Values
TPR14 Social Competencies
TPR15 Positive Identity
Community Impact Survey Part 3 of 3
Please select and rank 10 of the following 19 options below. Choose the demographics you believe would most benefit from targeted prevention services, ultimately having the strongest long term positive impact on your community and mark it with a 1. Mark the second highest with a 2. Continue this process until reaching 10.
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SP03 College Students
SP04 Children of Substance Abusers
SP05 Delinquent / Violent Youth
SP06 Economically Disadvantaged Youth / Adults
SP07 Older Adults
SP09 Elementary School Students
SP12 High School Students
SP14 Middle High School Students
SP15 Parents/ Families
SP16 People Using Substances
SP17 People with Disabilities
SP18 People with Mental Health Problems
SP19 Physically/ Emotionally Abused People
SP20 Pregnant Females
SP20 Women of Childbearing Age
SP21 Preschool Students
SP24 School Dropouts
SP26 Youth / Minors
SP28 Gays / Lesbians
Personal Commitment to NvCPC
We provide opportunities throughout the year where individuals and organizations can collaborate towards promoting individual, family, and community wellness. Placing a check beside each box will signify your willingness to engage in these efforts.
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Engage in opportunities for collaboration
Actively support at least one (1) of our social media channels
Actively promote participation in NvCPC funded programs
Volunteer to serve on one (1) Ad-Hoc committee annually (Four Hours)
Attend one (1) NvCPC community meeting annually (One Hour)
Consider NvCPC a source for community funding
Consider NvCPC a recipient for donations and grant funding
Support one (1) community program
Be a youth Mentor
Background Check
Volunteer Screening Authorization (Adults 18+ Only)
I agree to provide electronic authorization for Nevada Community Prevention Coalition Inc. to request a Multi-Court Criminal Database Search of Contributing Courts, National Registered Sex Offender Search, Comprehensive Address Trace, Alias Name Search, ID Validation, Single County Criminal Record Search, OFAC Patriot Act Search, and Adverse Action Letter search.
Fingerprinting
Fingerprint Card Submission (Adults 18+ only)
I agree to submit three (3) fingerprint cards within one week of submitting my volunteer application, at my own expense, completed by either 1) Las Vegas Metropolitan Police Department 2) Mesquite Police Department 3) Boulder City Police Department, to Nevada Community Prevention Coalition Inc. staff by appointment only.
Disclaimers
Selecting the box next to each statement signifies your agreement.
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This document is intended to solely signify community support from an individual or organization to NvCPC and does not bestow Individual or Common ownership nor management within NvCPC; all rights, privileges, accesses, material or intellectual property shall remain the sole exclusivity of NvCPC.
This document does not entitle the individual or organization to remuneration or reimbursement for any purpose.
I represent my answers are complete and true.
Digital Signature
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Date Submitted
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Parent / Legal Guardian Digital Signature
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Date Submitted
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