Network Advocate Application
(NOTE:  All information will be kept confidential.  You will be contacted for an interview by a DAWN representative). 

Today’s date ________________

Name___________________________________ DOB__________________________________

Local address :_______________________________________________________________________

Phone (_____)___________TTY/V    E-mail : _________________    Pager _________________

How did you find out about DAWN? ______________________________________________________________________________

Circle Y for yes and N for no. 

Y  N   Are you a member of the Deaf Community?            Y  N   Are you fluent in ASL?

Y  N   Do you have access to a car?

Y  N   Can you make a regular commitment (i.e., weekly) as a DAWN volunteer? 

Y  N   Have you been arrested?   If so, explain when and type of arrest.

Please answer the following questions in detail.  Explain and/or give additional information when needed.

Why do you want to become a DAWN volunteer advocate.