NEIGHBORHOOD CAPTAIN PROGRAM

Neighborhood Captain Application

Help neighbors connect, identify community needs, find useful resources and build a direct line of communication with Neighborly Giving Foundation.

Learn about the Captain role before applying

Website

Applications received by the 10th are considered during that month's review, and results are sent on the 15th. Applications received after the 10th are considered the following month. Do not submit Social Security numbers, identity documents, financial records, or criminal-history information.

Section 1 Applicant Information

First name

Last name

Name you prefer to be called

Are you at least 18 years old? Yes No

Email address

Mobile phone number

Preferred way to contact you Email Phone call Text message

Street address

City

State or province

ZIP or postal code

Country

Languages you speak

Do you need an accommodation to complete the application, interview, screening, training, or volunteer activities? No Yes Prefer to discuss privately

Section 3 Your Heart for the Community

These questions are not a test. If you are unsure or would like help thinking through an answer, say so and we can discuss it with you.

Why would you like to become a Neighborhood Captain?

Please share an experience that shaped how you think about neighbors, belonging, or community care.

What does being a trustworthy community advocate mean to you?

What personal strengths would you bring to this role?

How would you help someone feel welcome if they were new, shy, isolated, or different from you?

How do you feel about starting conversations with neighbors, even when it may take you outside your comfort zone? I feel comfortable starting conversations. I may feel nervous, but I am willing to try. I would feel more confident with coaching, conversation starters, or practice. I would prefer a mentor or team member to help me get started. I am not sure yet and would like to discuss it.

What support would help you feel more comfortable approaching or welcoming neighbors?

Describe how you would respond if two neighbors disagreed during a gathering.

Is there anything from your lived experience that would help you understand or serve your community?

Section 4 Community Needs and Your Contribution

What are the three most immediate needs you see in your community?

List Need 1, Need 2, and Need 3.

Which need would you most like to help address during your first year?

What is one practical, respectful first step you could take to help neighbors respond to that need together?

What support, information, partnerships, or resources would help make that first step possible?

What local organizations, schools, food banks, government offices, service providers, or community leaders are you already familiar with?

It is okay if you do not know of any yet. You may also ask for help identifying them.

Section 6 References

Please provide three adults who can speak about your reliability, judgment, communication, or care for others. By listing a reference, you confirm that you have permission to provide their contact information.

Reference 1

Reference 1 full name

Reference 1 relationship to you

How long has Reference 1 known you?

Reference 1 email address

Reference 1 phone number

Reference 2

Reference 2 full name

Reference 2 relationship to you

How long has Reference 2 known you?

Reference 2 email address

Reference 2 phone number

Reference 3

Reference 3 full name

Reference 3 relationship to you

How long has Reference 3 known you?

Reference 3 email address

Reference 3 phone number

Section 7 Background Screening Notice

Appointment is subject to an authorized background screening. Do not enter a Social Security number, government identification number, identity document, or criminal-history information here. If you continue, a separate disclosure and authorization will explain the process and your rights. A prior arrest or conviction will not automatically disqualify an applicant; information will be considered individually and under applicable law.

If invited to continue, are you willing to review and complete a separate background-screening authorization? Yes I would like more information before deciding No

Section 9 Privacy Notice and Data Consent

Effective October 7, 2026. Neighborly Giving Foundation uses application, communication, reference, interview, and later authorized screening information to review applicants, administer the program, protect participants, provide support, measure program results, and meet legal and recordkeeping obligations. Access is limited to authorized personnel and service providers with a legitimate need. Personal information is not sold or shared for unrelated advertising. Questions, correction requests, or permitted deletion requests may be sent to [email protected].

Privacy consent I have read the privacy notice and consent to the collection, storage, use, and necessary service-provider processing of my information for application review and program administration.

Reference contact I consent to Neighborly Giving Foundation contacting the references I provided.

Program communications I consent to application and program communications by email and, according to my preference, telephone or text message. Message and data rates may apply.

Program reporting I understand that program results may be reported using de-identified or aggregated information that does not reasonably identify me.

Section 10 Optional Story and Publicity Interest

Public participation is optional and is not a condition of approval or continued participation. A yes answer is not a media release; separate permission is required before identifiable material is published.

May we contact you later about a possible story or testimonial? Yes, you may contact me. No, please do not contact me for this purpose.

Section 11 Electronic Signature

By signing below, you confirm that you are the person submitting this application, have reviewed the role and terms, and intend your electronic signature to have the same effect as a handwritten signature.

Electronic signature

Type your full legal name.

Printed full legal name

Signature date

Electronic records I agree to use an electronic record and electronic signature when submitting this application online.

Required field