Volunteer Application

Complete this form to apply to be an ACCESS RJ Volunteer

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Cell Phone(Required)

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address City State ZIP Code

Gender Identity(Required)

If your gender identity was not listed, please provide it in the space below.(Required)

Preferred Pronouns(Required)

She/Her

She/They

They/Them

He/Him

He/They

None, use my name

Decline to Say

Not Listed (Write In)

If your pronouns were not listed, please provide them.(Required)

Race/Ethnicity (Select All That Apply)(Required)

If your race/ethnicity was not listed, please provide additional information.(Required)

Languages You Speak (Select All That Apply)(Required)

If you speak any languages other than those listed, please provide additional information below.(Required)

What types of support are you interested in providing?(Required)

Transportation

Escort

Funding

Rallies

Testifying

Phonebanking

Tabling

Comfort Kits

Doula/Emotional Support

What interests you most about ACCESS?(Required)

Do you have lived-experience with abortion? (Lived-experience can be categorized as you having had an abortion and/or you supporting someone that had an abortion)(Required)

Yes, I have had an abortion.

Yes, I have helped someone navigate an abortion.

No, I do not have lived-experience.

If you answered yes to the question above, did you or the person navigate abortion care before or after the Dobbs verdict in June 2022?(Required)

I had an abortion/helped someone navigate an abortion BEFORE June 2022

I had an abortion/helped someone navigate an abortion AFTER June 2022

I had an abortion/helped someone navigate an abortion before AND after June 2022

Barriers exist to navigating abortion care even here in California. Please select which options best describe the barriers you or the person you helped experienced when navigating abortion care:(Required)

Transportation

Lodging

Finances (unable to pay out-of-pocket procedural costs)

Finances Other (unable to acquire time off, childcare, housing insecurity, unable to pay for groceries for family

Provider limitations (distance from provider, unable to acquire timely appointment, unsatisfactory treatment)

Gender Identity

Stigma (personal, religious, media, misinformation)

Risk of Criminalization

Other

If you answered "Yes, I have had an abortion", please select what best described your insurance situation when you received your abortion:(Required)

I had private health insurance.

I had Medi-Cal health insurance.

I did not have health insurance at the time.

I am unsure.

What special skills, perspectives, experiences can you bring to this work?(Required)

Please tell us what Reproductive Justice and Intersectionality in abortion access means to you.(Required)

What are your thoughts and feelings about abortion? If you feel comfortable, please share any personal experience you may have had with abortion care.(Required)

Please list any current or previous volunteer roles, including names and location of the organizations(Required)

Driver's License Number(Required)

Do you have reliable access to a car?(Required)

Yes

Please check your ideal availability throughout the current year. Select all that apply.(Required)

This information is not set in stone. You will be able to update it as your situation changes, and we will reach out to you from time-to-time to make sure everything is still current.

What is the maximum number of miles you are willing to drive round-trip?(Required)

Please enter numbers only. We locate volunteers based on the number of miles from the caller and/or clinic.

Can a caller bring a friend, partner or child with them?(Required)

Yes

Do you have access to a child's car seat?(Required)

Yes

If you answered "Yes" to having a car seat, please check all that apply below.(Required)

Rear facing

Forward facing

Booster with back

Booster without back

Weight restrictions

Can people smoke in your car?(Required)

Yes

Describe your vehicle (year, make, model, color)(Required)

Car insurance info (carrier, policy number)(Required)

References

Please provide two references below: (1) professional, either coworker or supervisor, (2) personal

Reference 1 Name(Required)

Reference 1 Relationship(Required)

Please describe.

Reference 1 Phone and Email(Required)

Reference 2 Name(Required)

Reference 2 Relationship(Required)

Please describe.

Reference 2 Phone and Email(Required)