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Volunteer Application


Please answer the questions below so that we can schedule an orientation appointment at a nursing home.

There are some short answer questions after the contact information. There are no right or wrong answers to any of the questions. Your answers are only used to help us support you better, and to match you up with a nursing home resident.

Contact Information

Name:

Address:

City, State, Zip:

Phone (day):

Phone (evenings):

Email:


General Questions

1. How did you hear about us?

 

2. What kind of work are you in? If you are a student, what do you study?

 

3. In a few sentences, describe your motivation for wanting to visit the elderly.

 

4. In a few sentences, tell us about your likes and dislikes. This can be helpful to us in matching you up with a person with similar interests.

 

5. What days of the week and times are generally best for you to visit the nursing home?

 

6. What past experience do you have with volunteering, especially volunteering in health care situations? Do you have any other past experience that you think would be relevant to this sort of volunteering?

 

References

Please provide two character references below. At least one of these should be an authority figure -- i.e. current/former employer, teacher, pastor/minister, etc. Neither should be a family member.

Reference 1

Full Name

Phone

How do you know this person?

Reference 2

Full Name

Phone

How do you know this person?


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Home > Get Involved > Volunteer Application

 

"A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE. 1-800-HELP-FLA (435-7352) OR www.FloridaConsumerHelp.com. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE." FLORIDA REGISTRATION CH14633