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Get Involved in Potter's House

Involvement Application

Thank you for your interest in Potter's House! Please complete the following information to help us get you involved in Life Together programs in Fayetteville, Arkansas.

Note:
If you are interested in volunteering at the Thrift Store, you do NOT need to complete this application. Simply send an email to chad@phnwa.com with your name and availability. 
1. How are you hoping to become involved in the Potter's House community? (Click all that apply).

[NOTE: All interest forms will be sent to the appropriate staff based on interest. Each program has limited space. When there is available space, staff will reach out to the parents/guardians to schedule a meeting to discuss the eligibility and requirements for each participant in order to assess if the program is the best fit for Potter's House and for the family in interest.
2. If you have already spoken or corresponded with a Potter's House staff member, please provide the staff members name below:
3. Please fill out the information below.
This question requires a valid email address.
This question requires a valid number format.
This question requires a valid date format of MM/DD/YYYY.
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4. Address (Where you currently live and/or receive your mail)
6. Do you live at this address year round?
7. If you do not live in Northwest Arkansas full time, please provide a mailing address where you can be reached? (i.e. You stay with your parents at another location during University breaks)
7. What program(s) are you interested in volunteering for? (Click all options of interest).
7. What days and times are you available to volunteer? Write the times in the boxes below for each day.
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7. Do you have any experience working with children or teens?
7. Are you looking to volunteer to receive credit for a university class or sorority? *This question is required.
7. Please list 3 references:
Space Cell NameEmailPhoneRelationship
Personal Reference #1 (cannot be a family member)
Business/Professional Reference
Another Personal or Professional Reference (cannot be a family member)
7. Please provide some information on your educational background.
7. Please read through the following statements and click to confirm that you provide consent to any or all. (All consents will remain valid unless the applicant communicates to Potter's House staff via email to Kelsey@phnwa.com that consent has been withdrawn.)
8. If Potter's House staff needs to contact an emergency contact on your behalf, who should we call?
9. Since you are looking to involve your family, please provide the information for your spouse/partner. If you have children, this can be secondary parent/guardian (if applicable). This is helpful information for us as we hope to integrate the entire family unit into our Potter's House community. 
This question requires a valid date format of MM/DD/YYYY.
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9. Please provide us with the information for the first child in your household (if applicable).
This question requires a valid date format of MM/DD/YYYY.
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If you are interested in signing up this child for a Potter's House program, please indicate all that apply below:
9. Do you have another child in your household?
9. Please provide us with the information for the 2nd child in your household.
This question requires a valid date format of MM/DD/YYYY.
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If you are interested in signing up this child for a Potter's House program, please indicate all that apply below:
9. Do you have a 3rd child in the home?
9. Please provide us with the information for the 3rd child in your household.
This question requires a valid date format of MM/DD/YYYY.
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If you are interested in signing up this child for a Potter's House program, please indicate all that apply below:
9. Do you have a 4th child in the home?
9. Please provide us with the information for the 4th child in your household.
This question requires a valid date format of MM/DD/YYYY.
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If you are interested in signing up this child for a Potter's House program, please indicate all that apply below:
9. Do you have a 5th child in the home?
9. Please provide us with the information for the 5th child in your household.
This question requires a valid date format of MM/DD/YYYY.
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If you are interested in signing up this child for a Potter's House program, please indicate all that apply below:
9. Do you have a 6th child in the home?
9. Please provide us with the information for the 6th child in your household.
This question requires a valid date format of MM/DD/YYYY.
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If you are interested in signing up this child for a Potter's House program, please indicate all that apply below:
9. Do you have a 7th child in the home?
9. Please provide us with the information for the 7th child in your household.
This question requires a valid date format of MM/DD/YYYY.
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If you are interested in signing up this child for a Potter's House program, please indicate all that apply below:
Thank you so much for taking the time to answer these questions.