Volunteer Application

Thank you for you interest in becoming a Beacon Hospice Volunteer. Please complete the following application. All information will be held strictly confidential.

Personal Information

First Name: *

M.I.:

Last Name: *

Address: *

Apt.:

City: *

State: *

Zip Code: *

Home Phone: *

Alternate Phone:

Email: *

This information is optional and is for informational purposes only:

Are you older the age of 18?:	Yes No	Gender: Male Female
Education Level:	High School Doctorate	Associate Trade	Bachelor Other	Master
Ethnicity:	African American Native American	Caucasian Other	Asian	Hispanic

Job Information

Are you Employed?

Yes No Hours Worked:

Job Title:

Work Location:

Emergency Contact Information

First Name:

M.I.:

Last Name:

Address:

Apt.:

City:

State:

Zip Code:

Home Phone:

Alternate Phone:

Email:

Relationship:

Volunteer Information

Have you ever done volunteer work? Yes No

(If yes, please explain)

Have you had any experience with end-of-life care? Yes No

(If yes, please explain)

Have you experienced a significant loss in your life within the last two years (i.e. death, divorce, job loss, other?) Yes No

(If yes, please explain how you think this would/would not impact your work as a hospice volunteer)

Have you had any study or training in the area of grief and/or loss? Yes No

(If yes, please explain)

Do you belong to any clubs and/or organizations? Please list:

What do you believe you can bring to the patients and families you may visit?

Volunteer Areas of Interest (Please check all that apply)

Direct Patient Care – Provide support and companionship to patients and families

Phone Support – Provide weekend support phone calls to patients and families

Sitting Vigil Volunteer – Spend time with patients as they are actively dying

Complementary Therapy Volunteer – Provide healing therapies (reiki, massage, etc.) to patients.
(Must provide proof of licensure and/or training.)

Spiritual Support Volunteer – Assist with spiritual needs such as praying, saying the rosary, etc
(These services provided ONLY at the REQUEST of the PATIENT)

Family Support Volunteer – Provide respite care to patients/families

Language Skills (Please enter languages spoken and indicate level of ability)

Speak	Read	Write
Speak	Read	Write
Speak	Read	Write
Speak	Read	Write

Additional Information

Do you drive? Yes No Do you have access to a vehicle? Yes No

Please tell us anything else you would like us to know:

I hereby request Beacon Hospice to process my application to become a volunteer. I have completed the application to the best of my ability and state that all information that I have provided is true and accurate to the best of my knowledge.

Volunteer Application

BEACON NEWS

BEACON EVENTS

BEACON OPPORTUNITIES