Men Standing Up Volunteer Application Volunteer application for MESA program Personal InformationDate* Name* First Last Gender and pronouns*Birth date*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* If you are a student Name of school Current year Employer Company How long Position How long have you lived in Colorado?Do you have access to transportation?* Yes No Do you have any physical limitations that require accommodation?* Yes No Please list any languages that you speak fluently besides English*References (preferred: two professional, one personal)Reference #1* Name Phone Email Relationship Years Known Reference #2* Name Phone Email Relationship Years Known Reference #3* Name Phone Email Relationship Years Known Interests and Time CommitmentHow did you hear about volunteering with MESA?*Reasons for Volunteering (in brief)*List two major strengths when working with people*List two major weaknesses when working with people*Please list any anticipated short or long-term absences longer than two weeks*Describe your time commitments in a typical week (outlining mornings, afternoons, and evenings both weekdays and weekends)*BackgroundHave you ever been terminated or released from a job or volunteer experience?* Yes No If yes, please explainHave you ever been convicted of or pled guilty to a criminal offense in a court of law?* Yes No If yes, please give dates, details and penalties for each occurrence in a separate document. A "yes" does not automatically remove you from consideration for volunteering for MESA.Men Standing UpHow do you imagine that utilizing male privilege might be helpful in movements to end sexual violence? How can you imagine that unchallenged male privilege might have a negative impact on collective efforts to end violence?*How do you feel about receiving coaching, direction, and feedback from female-identified leaders? Do you predict that this may be different and/ or challenging for you?*What is your understanding of how male privilege and/or masculine privilege might manifest in discussions about social justice, gender issues, and anti-violence?*Please describe any relevant background or experience that you may bring to this particular volunteer work. (Note: No prior experience is required.)*Please check all that apply Conducting educational presentations in schools and the community. Providing community awareness (helping with outreach events, booths, flyers). Providing support with social media. Providing general support (MESA events, office needs). Please check all that apply I am able to attend one meeting per month from 2:30-4:30pm on the 2nd Monday. I am willing to attend at least three program events each year. I am willing to arrange my own transportation for meetings and presentations. For those interested in being a presenter: I am able to attend a 20-hour training program. I am available to conduct daytime presentations of 60-90 minutes in length I am interested in (please check all that apply) Providing general support to MESA office needs, including posting of flyers and reaching out to other organizations, sending letters, making needed calls, compiling databases, etc. Providing support on preparing events and attending MESA annual events. Providing support with social media. Providing support in fundraising activities. CertificationI certify that all information provided on this application is correct. In consideration of my acceptance of this volunteer position, I, the undersigned, do waive any and all claims for myself and my heirs against Moving to End Sexual Assault (MESA), Mental Health Center of Boulder and Broomfield Counties, Inc., any sponsors or exhibitors, and all officials and volunteers involved in this event for any injury or illness which may directly or indirectly result from my participation with Moving to End Sexual Assault even though their liability may arise out of negligence or carelessness on their part. Name First Last Date CommentsThis field is for validation purposes and should be left unchanged.