UCR Escort Service

campus safety escort service: volunteer application
Name:
E-mail:
School Address:	Apt. or Dorm #
City:	State: Zip:
Permanent Address:	Apt. or Dorm #
City:	State: Zip:
Permanent Phone:	( ) -
School Phone:	( ) -

campus safety escort service: volunteer application
Class Standing:
Are you currently enrolled in the UCR Honors Program? Yes No
Please list two people who are not related to you who would give you a reference or recommendation (i.e. professor, work supervisor, resident advisor, etc.). Please include their phone number and their relationship to you.
Name: Relationship: Phone:
Name: Relationship: Phone:
Please select your work availability in order of preference (Note: You are expected to arrive to your shift 10 minutes early and stay 10 minutes late.):

campus safety escort service: volunteer application

When answering the following questions, please do not give vague generalizations, like, "I want to help," or, "It's a good cause." We would like to know your own feelings and ideas.

Why are you interested in this specific service?

Please tell us what you know about the problem of rape, as well as your feelings about this issue.

Since the Escort Service relies on volunteer integrity and commitment, please explian what commitment means to you.

campus safety escort service: volunteer application

Have you ever been convicted of any court offense, not including: 1)minor traffic violations; 2) any offense which was finally settled under Welfare and Institutions Code Section 781 (sealing of records) or Penal Code Section 1203.45 (a minor's petition of sealing of records); and 3) any conviction specified in Health and Safety Code Section 11361.5 )this code pertains to various marjiuana offenses)?

Yes No

Upon being selected, I understand the commitment that the Escort Service requires of volunteering 2 hours per week for one or more quarters (including finals week). I certify that all statements on this application are true and complete to the best of my knowledge and belief.

I Agree

campus safety escort service: volunteer application

Your application is being submitted. . .