Msp Guest Volunteer Application Form

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MSP GUEST VOLUNTEER APPLICATION FORM
Today’s Date:_______ Name:__________________ Name/Date of event: _____________/
/
/
Date of Birth:
/
/
Gender:
Female
Male
Social Security Number:
-
-
Residence:
Address:
Phone: (
)-
-
City:
State:
Zip Code:
Emergency Contact:
Name:
Address:
Phone: (
)-
-
City:
State:
Zip Code:
Have you ever been convicted of a felony or misdemeanor?
Yes
No
If so please explain:
Are you related to an offender supervised by the Montana Department of Corrections?
Yes
No
If so please list their name(s) and you relationship to them:
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
Are you on the visiting list of an offender supervised by the MDOC?
Yes
No
If so please list their name(s) and you relationship to them:
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
Are you the victim of a crime committed by an offender incarcerated at MSP?
Yes
No
If so please list their name(s):
Name:
Name:
What is service you’ll provide as a Religious Activities Guest at Montana State Prison?
CON check
Special Activity Form Submitted?
Training Packet Sent?
Special Activity Form Approved/Distributed?
Verification Returned?
Special Equipment

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