MyImpactPage - Pre-Licensed Mental Health Provider Volunteer Application

VTMHI Volunteer Policy

By submitting this volunteer application, I agree to adhere to the following policies.

1) Confidentiality Agreement: ACCESS TO and PROTECTION of CONFIDENTIAL INFORMATION During my work, I will have access to certain personal and valuable information about clients, staff, and the clinics. Such information includes, but is not limited to, personal information, situations, medical and social history, employment, finances, and other personal information. (Such information collectively is the “Confidential Information.”) I acknowledge and agree that all the Confidential Information is to be kept strictly confidential. No reference shall be made inside or outside the organization about a client’s identity, situation, treatment or other confidential information.

2) Volunteer Policies: I agree to volunteer policies outlined in the Volunteer Handbook. I represent that I am competent to contract and have read and fully understand the contents, impact and meaning of these policies.

I am new to MyImpactPage.com

You will need to enter a unique username to identify yourself to the system. You should select something that is easy for you to remember such as your email address or your name. Your username must be at least 6 characters long. If the name you enter is already in use by someone else, you will be prompted to choose another username.

Username

Required

	Username must not start with space
	Username must not end with space
	Username must not have two or more spaces in a row

Email Address

Required

Verify Email Address

Required

I have read and agree to VTMHI's volunteer policy. Required

I already have a username

If you have signed up with this organization before, or are a member of another organization that uses MyImpactPage.com, you can use the same login to access all organizations with which you are associated.

Username	Required
Password	Required
Forgot your username or password?
I have read and agree to VTMHI's volunteer policy. Required

Already use MyImpactPage.com to volunteer with this organization? Go to volunteer login

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