Volunteer Application Form

First name

Last name

Phone

Cell phone

Date of birth

Marital status

Gender

Ethnicity

Number

Street

City

State

Zip Code

Areas of Interest for Volunteers

Advocacy

Assistance with Handyman Chores or Repairs

Assisting with Correspondence

Computer Assistance-MAC

Computer Assistance-PC

Dog Walking

Friendly Check In Phone Calls

Friendly Visit to a Member’s Home

Gardening

Grocery/Meal Delivery

Note-taking at Medical Appointments

Organizing

Paperwork or Application Assistance

Run Local Pick-Up and Delivery

Scheduling Appointments or Other Assistance with Calls

Technical and Home Office Support

Transportation

Walking Buddy

First reference name

First reference email

First reference cell phone

First reference phone

First reference relationship

Second reference name

Second reference email

Second reference cell phone

Second reference phone

Second reference relationship

Previous Volunteer Experience?

Do you have current and valid drivers licence?

Do you have current and valid car insurance?

Mobility issues

Employment status

How did you hear about us

Additional Comments

I confirm that I have read, consent and agree to Revolutionaging’s (Helpful Village’s) TERMS OF USE and PRIVACY POLICY

Thank you for your interest

Thank you for your interest and we will be in touch with you very soon!