Volunteer

Volunteer Application Form

(Required fields are marked *)

First name: *

Last name: *

Address 1: *

Address 2:

City: *

State: *

Zip: *

Phone: *

Alternate phone:

E-mail: *

Best time to contact: *

Preferred method of contact: *

Occupation:

Employment status:

Full time Part time Retired

Employer:

Street:

State:

Zip:

Education/field of study:

Volunteer experience:

Other community involvement (e.g., organization, faith community):

Special skills/hobbies (e.g., computer, music):

Language skills:

Do you have transportation?

Yes No

How did you learn about volunteer
opportunities with Midwest CareCenter?

Type of service that interests you: (check all that apply)

Patient & Family Care Services		Patient support (Companionship/socialization/respite)
		Sitting with patients at the very end of life
		Inpatient Hospice Unit
Bereavement Support		Families with Children
Bereavement Support		CampCare
Office Support		Front-desk reception (Glenview)
		Office Lifts (group projects, such as mailings)
		Special department projects
Community Service & Special Events		Events
		Health fairs/expos
		Caring Kids in Action (Intergenerational service program)
		Memorial service hospitality
		Speakers bureau
		Jewish Care Services
Leadership & Planning		Service Board
		Friends of Jewish Care Services
		Board of Directors

Have you experienced any deaths in your family or of those close to you?	Yes No
Please specify your relationship to the person(s) and when he/she died.
Why would you like to be a hospice volunteer?*
To help us find the right assignment for you, please provide any additional information you feel would be useful.