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

Your preferred name is how you will be referred to in all correspondence and while volunteering with GRPC.

Birth Date

This is required for background check. Facilitators must be at least 21 years of age.

Legal Sex

Pro-nouns

Which languages are you fluent in?

Reference 1

Reference 2

Employer 1

Employer 2

Employer 3

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.

Background Check

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.

Please type your full legal name and the date you are submitting this application on as your electronic signature.

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