Full name*
Email address*
Phone*
Street address
Emergency contact name*
Emergency contact relationship
Emergency contact phone*
Emergency contact address
How did you learn of this volunteer opportunity?*
If attended an event that inspired you to join, what was the event?
Please provide two references from people who are not related to you.
FIRST REFERENCE
Relationship to you*
Email
Address
SECOND REFERENCE
Why are you drawn to this work?*
What is your availability, in general? For instance, are you available only the first Sunday of every month? Are you available every weekend? etc.*
What is the best time to call you?
What kind of support can you offer? Please check all that apply.* Support Team LeaderLiaison with host and guest: ensure well-being of guest, keep communication open, help resolve any household issuesMaterial needs: ensure adequate food, clothing, household items, organize shopping, tech support with computers and cell phones when necessaryMedical/dental/psych liaison with providersTutoring in EnglishDevelopment committee: fundraising in the time of Covid is challenging, but we can have creative fundraising and meet our needs of sponsorshipTransportation for doctor appointments or shopping, etc.Social/recreation/community involvementCell phone set up with program and tech helpVolunteering liaison (coordinate volunteer opportunities for guest who can’t work yet)Other
If other, please indicate here:
Do you have any physical limitations for jobs that require physical activity? Please specify.*
Can you provide proof of vaccination and booster?* YesNo
Is there anything else you would like us to know at this time?