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Helpline: 24/7 Call or Text 904.225.9979 All our services are free and confidential. Admin: 904.491.6364

Volunteer Application

First name*

Last name*

Birth Date*

Month

Day

Year

Email*

Phone Number*

Address*

Emergency Contact*

Phone Number*

Are You Interested in Working Events?

Which Store Would You Prefer?*

Do You Have Any Volunteer Experience? If Yes, Please Describe.*

Are you needing to collect volunteer hours for anything specific?*

What days are you available?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

From what time are you available?

Time*

Time

:

To what time are you available?

Time*

Time

:

Signature*

Date

Month

Day

Year

Micah's Place

Nassau County Florida's only Certified Domestic Violence Center. Our mission is to provide safety and support to those experiencing violence and raise awareness regarding it's cause, prevelance and impact.

Email: info@micahsplace.org

Phone: 904-491-6364

Registered Charity: 59-3675485

P.O. Box: 16287 Fernandina Beach FL, 32035

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