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Companion Communities Application

 

part i application

 (Due March 1, 2010)

   

Questions?

 

Please contact Rev. Mary Schaller Blaufuss, Executive for Volunteer Ministries

700 Prospect Ave. E, Cleveland, OH  44115-1100

Phone:  (216) 736 3214 or toll-free (866) 822-8224 ext. 3214
Fax: (216) 736-2294 *  Email:  blaufusm@ucc.org
UCC Companion Communities do not discriminate against applicants on the basis of religion, race, color, national origin, sex, age, sexual orientation, or disabilities.

 ***************************

 
  • Community Living
  • Hands-On Justice Advocacy/Service Opportunities
  • Leadership Development
  • Faith Conversations
This introductory application allows Volunteer Ministries staff to get to know the experiences and skills you offer for a volunteer placement.  Completion of this form begins the application process but does not commit you to participation nor guarantee placement.  Volunteer Ministries staff will electronically send you the second part of the application and forms for written references which are due no later than March 15th.  Final notification of placement by April 30, 2010. 
   
Application Dates - Application Part I due March 1, 2010 & Application Part II INCLUDING 3 references due March 15, 2010.
Title 
Last Name
First Name
Address
City
State
Zip Code
Country
Phone
Cell Phone
Fax
E-mail Address
Date of Birth (mm/dd/year)
   
EMERGENCY CONTACT (Person who can always reach you)
   
Name 
Address
City
State 
Zip Code 
Phone
Cell Phone
Fax
E-Mail
   
Your Availability for  a Companion Community Placement 
(June - August, 2010  
 
   
Types of Skills and Experience You bring (Check all that apply) 
Languages Spoken or Written 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Your Experience: 
Class: 
   
 Possible Service Settings 
(Indicate Interest by 1, 2, 3, 4, 5 with 1 as little interest and 5 as great interest.)
   
Immigration & Border Ministries    
Inner City Ministries
Elders
Children 
Homeless Shelters 
Food Programs 
Worker's Rights 
Direct Social Service 
Community Organizing 
Other     
  Please Explain: 
   
 Companion Communities Locations
Church of the Beatitudes, Phoenix, Arizona  September 2010 - June 2011
Setting:  Child Care, Oral History Project with Elders, Refugee and Immigration Services, Case Worker
   
Westmoreland Congregational UCC, Bethesda, Maryland Sept. 2010 - August 2011
Setting:  Washington, DC-Case Workers fields of health care, homeless pupulations, social services   
   
       
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Contact Information
Mary Schaller Blaufuss
Executive for Volunteer Ministries
Global Sharing Of Resources
Wider Church Ministries
700 Prospect Ave.
Cleveland,Ohio 44115
216-736-3214
blaufusm@ucc.org

Tonya Pettigrew
Administrative Assistant
Partner Relations Ministry Team
Wider Church Ministries
700 Prospect Ave.
Cleveland,Ohio 44115
216-736-3216
pettigrewt@ucc.org