Volunteer roles desired

Volunteer Interest Form

Thanks for your interest in becoming a volunteer with us! We can't wait to get to know you better.

How would you like to help? Please check all that apply!

Armchair Advocate (raise awareness on social media)Sharing my story publicly (via social media, speaking, or traditional media)Local community team. (start a volunteer team in your own community or join an existing one)Young Allies (focus on young-onset issues--variety of roles available)Buddy (support someone with a like journey over internet or phone)Community events (find local community events and represent us)Outreach (to welcome, thank, or encourage participation from other allies by phone or handwritten card) DIYnamo (create your own fundraiser based on your passion, start a Dress in Blue Day, online donation page honoring a loved one, Facebook fundraiser) Walk to End Colon Cancer (event day support or help plan your local Walk)

In what ways are you happy to share your story? (Check all that apply.)

In-person speaking with a groupSocial mediaVideo for Alliance website and/or social mediaRadioPrint mediaTelevisionIf I have an email template or script, I am also comfortable pitching a colorectal cancer story to my local media.

Local team interest (Check all that apply.)

Join a volunteer team, if available in my areaHelp start a local volunteer team

Young Allies interest (Check all that apply.)

In what ways are you open to connecting with a Buddy? (Check all that apply.)

Through the Alliance Facebook community Blue Hope NationThrough e-mailOver the phone

What is the farthest you are willing to travel to represent us at a community event?

5-10 miles11- 25 miles26-45 milesUp to 60 miles

DIYnamo interest (Check all that apply.)

Create your own fundraiser Dress in Blue Day Blue Star Tribute Page to honor a loved one Facebook Fundraiser

Salutation

Legal First Name

Legal Last Name

Birthdate

Select from the calendar (MM/DD/YYYY)

Connection to Colorectal Cancer

Patient/ SurvivorCaregiver/ Family MemberHealthcare ProfessionalOther

In a sentence or two, tell us what made you want to volunteer with the Alliance. (We are so glad you are here, by the way!)

Other

In the future, all volunteers will receive an Alliance T-shirt. Please select your preferred size.

Demographics

Gender

Age

Ethnicity

Race

How did you hear about us?

How did you first hear about the Colorectal Cancer Alliance volunteer program?

Web search (Google, etc.)The Colorectal Cancer Alliance (our website, social media/Blue Hope Nation, helpline or an email from us)Written materials in an officeAn eventSomeone I knowAnother organization

How did you first hear about the volunteer program from the Colorectal Cancer Alliance?

Which organization?

Which event?

Whom may we thank?

If you have helped the Colorectal Cancer Alliance in the past, tell us how! (Please check all that apply.)

Availability

When do you have availability to volunteer? (Please check all that apply.)

Weekday mornings Weekday afternoons Weekday evenings Weekends

Do you have regular access to the following? (Check all that apply.)

ComputerE-mailInternet Smartphone

Skills and interests

Language(s) Spoken

What other skills do you wish to share?

Please share any professional, volunteer, or life experience that will help us know how to best use your skills!

Help us make new allies

Our allies can often help us create strategic partnerships to spread awareness, etc., by making introductions for us. Current employers and an alumnus' connection to a school can really help, as many organizations have health fairs and other ways to connect.

School(s) you attended

Employer

Code of Conduct

Considering my opportunity to serve as a trusted volunteer ambassador for the Colorectal Cancer Alliance, I agree to uphold the Organization’s standards with the utmost integrity.

All volunteers shall abide by and conform to these professional standards:

Volunteers shall act honestly and ethically while in the performance of their volunteer duties.
Volunteers shall treat all Alliance employees, volunteers, and community members with respect, courtesy, and dignity.
Volunteers shall not discriminate and shall be respectful of ethnic, national, and cultural differences.
Volunteers shall not harass, bully, or mistreat staff or other volunteers.
Volunteers shall obey all applicable local, state, and federal laws, while acting on behalf of the Alliance, including all laws and regulations that govern appropriate conduct in the workplace.
Volunteers shall deter wrongdoing and ensure accountability for adherence to the Code of Conduct.
Volunteers shall assist and cooperate with all Alliance investigations.
Volunteers shall report violations or suspected violations of the Code of Conduct. Violations should be reported to the assigned staff partner, their manager, or volunteer@ccalliance.org.

I understand that Privileged Information includes, but is not limited to, information about the Alliance’s Development program, its donors, event participants, constituents, and prospects, such as:

Names
Contact information (including phone number, email address, or mailing address)
Giving history
Funding areas of interests
Event participation history
Connection to colorectal cancer
Medical/patient information

As a volunteer representing the Alliance, I understand and agree to the following:

If the Alliance provides me with Privileged Information, it is in strict confidence to enable me to perform my functions as a volunteer.
I will never use Privileged Information for any purpose other than my volunteer service with the Alliance.
I will not share Privileged Information outside of Alliance's staff.
I will ensure the Privileged Information I receive is kept safe and secure from any unauthorized access, which includes preventing access to my computer, devices, email, or any other access point(s) that I control to Alliance's data.
I will never copy the Alliance’s data, whether electronically or on paper, except when it is necessary to address an envelope, write a letter, or write an email as part of my volunteer service.

I attest that I am over the age of eighteen, of sound mind, and have read, understood and agree to all of the terms herein.

Media Release Form

In consideration of my opportunity to be included in media produced and/or published by the Colorectal Cancer Alliance (Alliance), I grant the Alliance and its successors, licensees and assigns, unlimited rights to the video and photos I submit through this form (Material). These rights include the right, but not the obligation, to use, modify, and publish this Material in any markets and media (whether now known or hereafter developed), throughout the universe, in perpetuity.

I warrant and represent that I have the right to grant all rights granted herein and that the Alliance’s use of the Material as permitted herein will not infringe on the rights of any third party. I will indemnify and hold the Alliance and its successors, licensees and assigns, harmless from and against any and all claims, damages, liabilities, costs and expenses arising out of any breach of the foregoing warranty and/or any use of the Material. I further understand and agree that (a) I shall have no right to inspect or approve any portion of the Alliance’s resulting productions and/or media, (b) I shall not be entitled to any compensation or credit by virtue of this release and (c) in no event shall I have the right to seek or obtain injunctive or other equitable relief in connection with the Material or the development, production, distribution or exploitation of any future Alliance media that includes the Material.

By typing my name below and submitting this form, I attest that I am over the age of eighteen, of sound mind, and have read, understood and agree to these terms.

Name

Agreements

I am at least eighteen years of age.

Yes

I understand that volunteers may be photographed and/or submit photographs, video and other media content for educational, archival, and public relations purposes for Colorectal Cancer Alliance.

Yes

Yes, I want to receive email updates from the Colorectal Cancer Alliance.

Yes, I want to receive periodic text updates from the Colorectal Cancer Alliance. Message and data rates may apply. Text STOP to opt out, HELP for info. Privacy Policy.