Sneak Peek: Placement Application

Sneak Peek: Placement Application

Dear Placement Applicant:  Thank you for your interest in LVC! The online application form does not allow you to save your work.  Please review the application areas below, and prepare your responses before opening up the application form.  You will complete the form all the way to the end, answering all questions, sign and submit.  You will not be able to access your application once you submit it, so please print a copy for your records.  If you have questions, contact LVC at, or 202.387.3222. Access the application HERE.

Thank you for your interest in partnering with LVC!  Please complete this form all the way down to the signature.  Once complete, click SUBMIT and then CLOSE.  DO NOT CLOSE THIS FORM until complete.  Once you submit, you can not make changes.  Contact LVC before starting the application if you have questions at 202-387-3222.


  • Application date
  • Application type
  • Placement
  • Partner Organization
  • Presenter/Trainer/Speaker
  • Select the volunteer terms you are open to hosting an LVC Volunteer
  • Year of Service: AUGUST – JULY
  • FLEX Semester: Fall (August – December)
  • FLEX Semester: Spring (January – May)
  • FLEX Semester: Summer (June – August)
  • Organization name
  • Executive director name
  • Email
  • Main phone
  • Address
  • Web site


  • Someone must be identified as the main contact for the partnership. Placement position supervisors will be listed on a separate POSITION FORM.
  • General contact name, email, title, phone, cell phone

If the person handling bills and invoices is different than the general contact, list that person here.  If not, leave blank.

  • Finance/invoicing contact name, phone, email


This information helps us describe your Placement for potential Volunteers. You will provide this information once.  When you apply for a new year, you will not need to complete this information again.

  • 501c3?
  • Fiscal year start month
  • Number of full-time employees
  • Number of part-time employees
  • Describe the demographics of your organization (approximate % race/ethnic, gender, age, managers/non-managers, etc.)
  • Brief mission statement
  • Brief history of your organization
  • What is the root injustice your organization addresses?
  • What are your organization’s key goals?
  • Key services and programs your organization provides
  • Does the population served participate in decision making for your programs or services? If yes, how?
  • What social justice focus best describes your organization?
  • Anti-Racism/Anti-Oppression
  • Education
  • Environment/Climate/Sustainability
  • Food Security
  • Health Care
  • Housing and Homelessness
  • Immigrants and Refugees
  • Law and Legal Justice
  • People with Disabilities
  • Poverty
  • Senior Citizens
  • Youth
  • Why is having an LVC Volunteer important to your organization? We would like to use your quotes in our promotional materials.


  • Attach your most recent 990
  • Has funding for the LVC position(s) been approved by leadership/governing body?

The Placement fee is determined by your organization’s total compensation for employees and officers, as reported in your 990 (or financial statement)

  • Total revenue from line 12 of 990
  • Total expenses from line 17 of 990
  • Total compensation, salaries, wages, benefits, pensions nd payroll taxes of officers and employees (Lines 25-29)


  • COSTS: Please check the box to confirm that the organization is prepared to pay the following additional costs for each Volunteer.
  • *Health Insurance Premium: Estimated to be between $355-450/month per Volunteer (only for Volunteers that require it)
  • Health Out-of-Pocket Costs: Up to $900 for additional deductibles, co-payments, pre-existing conditions, after $100 is spent by the Volunteer (only if Volunteers require it)
  • Auto Liability Insurance: Up to $95/month (only if a car is required for the position) plus mileage
  • Work-Related Travel: Costs to and from the Placement, and other work-related travel, typically provided as a monthly bus pass
  • *Placement vs. LVC-CVN Health Insurance Plan
  • YES: Placement will offer its health insurance benefit to the Volunteer.
  • NO: Placement requests that LVC offer the CVN health plan to the Volunteer, and Placement will reimburse LVC for the premium monthly.
  • If Placement wishes to offer its own health insurance plan to the Volunteer, what is the estimated monthly cost?
  • If Placement offers its own health insurance to the Volunteer, when do enrollment forms need to be returned by the Volunteer?
  • Is there a waiting period after date of hire for the Volunteer to enroll?
  • If yes, how long is the waiting period?
  • WORK POLICIES: The organization agrees to these work-related policies for each Volunteer
  • No more than a 40-hour workweek
  • Comp-time provided for unusual exceptions to the 40-hour workweek
  • LVC program days allowed and not counted as vacation/sick time (one program day off per month; two multi-day retreats; several Placement-Volunteer-LVC reviews)
  • LVC VALUES: The organization supports these LVC values and ideas in theory and practice.  Volunteers will be provided orientation on these subjects, and will expect that the Placement also supports these values/ideas.
  • Anti-racism/anti-oppression
  • Inclusion and diversity, particularly around race
  • LGBTQ welcoming and inclusion
  • Living simply and sustainably
  • Conflict resolution, importance of
  • Use of personal pronouns
  • ACCESSIBILITY: Please assess your organization’s accessibility to persons with disabilities.
  • Toilet and bathing facilities
  • Accessible|4
  • Partially accessible|3
  • In process of developing accessibility|2
  • Not accessible|1
  • Parking and passenger loading zones
  • Accessible|4
  • Partially accessible|3
  • In process of developing accessibility|2
  • Not accessible|1
  • Ramps
  • Accessible|4
  • Partially accessible|3
  • In process of developing accessibility|2
  • Not accessible|1
  • Elevators with accessible call buttons
  • Accessible|4
  • Partially accessible|3
  • In process of developing accessibility|2
  • Not accessible|1
  • Work Area: surfaces, clearance, telephones, braille, computer assisted technology for visual/hearing impaired
  • Accessible|4
  • Partially accessible|3
  • In process of developing accessibility|2
  • Not accessible|1