Volunteer Application

Choices Clinic Interest Survey (Please mark areas that interest you)

Client Advocate: Choices Clinic Counselor Training Provided

-Pregnancy Counseling/ Options Counseling (Abortion, -Adoption, Parenting)
-Post-Abortion Counseling
-Abstinence Counseling
-Spiritual Counseling
-STD counseling/education

Office: Choices Clinic Training Provided

-Answering the Phone
-General Clerical
-Data Entry
-Housekeeping
-Organizing
-Mail-Outs

Medical: Choices Clinic Training Provided. *Must be a medical professional.*

-Pregnancy Tests
-STD Testing Specimen Collection (urine)
-Medical follow-up calls
-Assisting staff nurses as needed
-Education regarding sexual health including pregnancy, -STDs, abortion, etc.

Off-Site: Project Training as Needed

-Intercessory Prayer
-Church Liaison- Represent Choices Clinic ministry to your local church body for special events, needs, or concerns
-Fundraising
-Group Class Instructor
-Sexual Education classes in schools
-Child Care
-Baby Store
-Website/Social Media

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Name

First

Last

Age

Date of Birth

Address

City

State

Zip Code

Home Phone

Cell Phone

Place of Employment

Number of Hours Weekly

Are you a student? If so, where?

Number of Hours Weekly

Martial Status

Spouse's Name

First

Last

Spouse's Employment

Phone

Do you have children?

Yes

How many?

Children Names and ages

Children names and ages cont.

Are they in good health?

Condition of your health

Church Membership

Pastor's Name

First

Last

Phone

Church Address

Church Positions and Other Responsibilities

Educational Background

High School

Graduation Date

College

Graduation Date

Other

Graduation Date

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Work Experience

Employer

Duties

Date

Reason for Leaving

Employer

Duties

Date

Reason for Leaving

Employer

Duties

Date

Reason for Leaving

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Volunteer Experience

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Pertinent Questions

1. How did you hear about us?

2. What makes you interested in volunteering at Choices Clinic?

3. What do you personally hope to gain from this experience?

4. How does your spouse or family feel about you volunteering here?

5. Would it be difficult for you to work with persons of a different faith than your own?

6. Would it be difficult for you to work with persons from a different race than your own?

7. Are you in the process of adopting a child or are you considering it due to infertility?

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8. Summarize your feelings on:

(a) Abortion: (include where you think life begins, etc.)

Would there be any exceptions to this? (Incest, rape, deformity of fetus, etc.)

(b) Adoption:

(d) Getting married due to pregnancy:

(e) Premarital Sex: (include your feelings on recommending birth control)

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9. Have you or someone you know ever experienced a “crisis pregnancy”? If so, please explain: (confidential)

10. Have you ever counseled a woman who has had any traumatic experiences related to abortion? If so, please explain: (confidential)

11. Have you ever sought an abortion for yourself or anyone else? If so, please explain: (confidential)

12. Please explain your view on how a person becomes a Christian:

13. Are you a Christian?

How Long?

14. Please write a brief description of your personal testimony:

15. How do you feel about sharing your faith with others?

16. Have you received training in this area? If so, please describe:

If not, are you willing to receive training?

17. Are you willing to confront someone tenderly about his or her lifestyle?

18. Are you open to constructive criticism?

19. Describe your personality. (Are you a people person, task oriented, etc?)

20. Skills/ Gifts/ Talents:

21. Weaknesses:

22. Are you able to work as part of a team?

23. Are you able to work on your own without supervision?

24. What questions or comments do you have about the center? (These can be discussed during your interview.)

Personal History:

Have you ever been arrested or convicted of a crime? If so, please explain:

Have you ever been accused of child abuse? If so, please explain:

Are you under any legal investigation for any reason (including IRS)? If so, please explain:

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I solemnly declare before God that the information in this application is true and correct to the best of my knowledge and that I will earnestly pray about where God wants me to serve him.

Full Name

Date

Please list two references in addition to your pastor. A reference form will be sent to each person to be completed and returned. Thank you!

1. Name

First

Last

Address

City

State

Zip Code

Phone

Relationship to you

2. Name

First

Last

Address

City

State

Zip Code

Phone

Relationship to you

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Purpose and Mission Statement

The PURPOSE of Choices Clinic is to uphold the biblical belief that God has created human life in His own image and that human life is sacred. Hence, human life should be safeguarded and protected from the moment of conception until natural death.
Therefore, the MISSION of Choices Clinic is to serve our community by empowering individuals to make life-affirming decisions through confidential medical services, education, and emotional support while compassionately sharing Biblical truth and Christ’s love.
In addition, for anyone who has been affected by abortion, Choices Clinic will offer a program to facilitate healing through the grace and mercy of Jesus Christ. We shall demonstrate our conviction within the bounds of Christian character and love, looking to the Scriptures to be our model and the Holy Spirit to be our Guide.
Therefore, the VISION shall be:

1) To be the FIRST CHOICE in our community for women and families facing unplanned pregnancies.

2) To eliminate the need for abortion by providing life-giving alternatives including parenting and adoption.

3) To educate our community from a biblical perspective on sexual health (including sexual purity and STDs) and pregnancy options.

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Statement of Faith

1. We believe the Bible to be the inspired, the only infallible, authoritative Word of God.

2. We believe that there is one God, eternally existent in three persons; Father, Son, and Holy Spirit.

3. We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and His personal return in power and glory.

4. We believe that for the salvation of lost and sinful man, regeneration by the Holy Spirit is absolutely essential and that this salvation is received through faith in Jesus Christ as Savior and Lord and not as a result of good works.

5. We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life and to perform good works.

6. We believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation.

7. We believe in the spiritual unity of believers in our Lord Jesus Christ.

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I solemnly declare before God that the information in this application is true and correct to the best of my knowledge and that I will earnestly pray about where God wants me to serve him.

Full Name

Date

Ministry of Care Statement

1. Since all clients are created in God’s image and are our neighbors, they are treated with the highest standards of Christian love, respect and care.

2. As an evangelical Christian ministry, this center ministers to all clients according to the standards and guidance of the inerrant sixty-six books of the Bible, which are the sole and final authority offering the love, compassion and mercy of Christ to all clients through both word and deed.

3. Since the centrality of Jesus Christ and His gospel of salvation, (which is by grace alone, through faith alone in Jesus Christ alone and by his imputed righteousness) are the ultimate and final hope for all women and men, the gospel is offered to all clients.

4. All clients are ministered to without regard for age, race, sex, income, nationality, religious beliefs, disability and other circumstances.

5. Clients of Choices Clinic always receive open and truthful answers. They receive respect and love regardless of their agreement or disagreement with the help offered.

6. All services, as well as pregnancy tests, are offered according to the law and proper standards.

7. Client information is held confidential except when federal and or state laws or biblical standards require disclosure to appropriate authorities, when necessary, to protect the client as well as others from imminent harm.

8. Choices Clinic provides accurate information from a Christian worldview regarding pregnancy, pregnancy termination, child development, lifestyle concerns, spiritual issues, and other relevant issues.

9. Clients are given only life affirming referrals to appropriate churches and other qualified sources of help. No referrals are given for pregnancy termination or abortifacients and only accurate information is given concerning pregnancy termination procedures and risks.

10. Choices Clinic is committed to loving the mother, father and child. It offers accurate information and education concerning marriage, parenting and parenting choices (adoption).

11. All public communications of services offered by the center are truthful and accurate.

12. All staff and volunteers receive Biblically-based volunteer training, encouraging them to act always in a spirit of love towards all clients without compromising their loyalty to Christ and His truth, using His methods, which form the basis of these standards.

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Statement of Principle

1. Choices Clinic is an outreach ministry of Jesus Christ through His Church. Therefore, Choices Clinic, embodied in its staff and volunteers, is committed to presenting the Gospel of our Lord to men and women, both in word and in deed. Commensurate with this purpose, those who labor as Choices Clinic board members, staff and volunteers are expected to know Christ as their Savior and Lord.

2. Choices Clinic is committed to integrity in dealing with clients, earning their trust, providing accurate information and services and eschewing any form of deception in its corporate advertising or individual conversations.

3. Choices Clinic is committed to assisting women to carry to term by providing emotional support and practical assistance, in order that through the provision of God’s people and the community at large, men and women may face the future with hope and plan constructively for themselves and their babies.

4. Choices Clinic does not discriminate in providing services because of the race, creed, color, national origin, age or marital status of its clients.

5. Choices Clinic offers free services at all times. Lab fees for STI testing may apply.

6. Choices Clinic is committed to providing its clients with accurate and complete information about both prenatal development and abortion.

7. Choices Clinic does not recommend, provide, or refer for abortion or abortifacients.

8. Choices Clinic is committed to creating awareness within the local community of the needs of women and families facing unplanned pregnancies.

9. Choices Clinic does not recommend, provide, or refer single women for contraceptives. Clients are educated on different types of birth control, along with failure rates and risks involved. (Married women seeking contraceptive information will be urged to seek counsel, along with their husband, from their pastor and physician.)

10. Choices Clinic recognizes the validity of adoption as one alternative to abortion, but is not biased toward adoption when compared to the other life-affirming alternatives. Centers are independent of adoption agencies, relating to them in the same manner as to other helpful referral sources. Choices Clinic receives no payment of any kind from these agencies, and does not enter into contractual relationships nor share combined office space with them. Adoption agencies are not established under the auspices of the center.
Choices Clinic neither initiates nor facilitates independent adoptions, though it may refer for independent adoptions in states where it is legal.

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