Solace Hospice Volunteer Application
Do you have a COMPANION's heart?
The word 'companion' is most often used as a noun. As a verb, however, it means, "to accompany".  To be a companion means to accompany someone on a journey. A companion volunteer is not only a friend who keeps another person company, but in its truest sense, a Solace Hospice Volunteer selflessly provides their encouraging presence to hospice patients as they accompany them, and their families, on what is often their final journey.

If this describes you, please complete and submit the form, below, and we will contact you for an interview.
 
1.
Your name (first, middle initial, last) 
 

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2.
If you would like to be considered for a volunteer position, please enter the information requested below, and we will contact you.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

Home Phone:
Email Address:
emailaddress@xyz.com
Cell phone:
Text:

3.
How would you prefer for us to contact you?

Home Phone
Email Address
Cell Phone
Text
4.

 What experiences with volunteering have you had? 

 

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5.
What did/do you like BEST about your volunteering experiences?

 

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6.
What did/do you like LEAST about your volunteering experiences?

 

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7.
What makes you want to become Solace Hospice Volunteer?

 

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8.
Please tell us which of the following describes your interest in providing
direct PATIENT CARE and family supportCheck all that apply. 

Provide companionship
Read to, write letters, or play music
Provide Veteran-to-Veteran volunteer services
Prepare simple meals, do light housekeeping
Create family histories, organize photo albums
Play games, do a craft project
Give primary care givers a break occasionally
Do nails, brush hair, share 'touch' (skin-to-skin contact)
Other  
9.

Please tell us which of the following describes your interest in providing direct HOSPICE SUPPORT. Check all that apply. 

Office assistance, answer phones, filing, etc.
Computer support
Assemble recruitment or marketing folders
Help plan/host appreciation and/or training events
Participate in community outreach activities
Sewing or other projects that benefit patients (lap blankets, fidget mats)
Send out birthday and thank you cards
Monitor/produce Social Media
Other  
10.

 Have you experienced a significant personal loss in the past year? (Close Relationship--spouse, family, friend; Career; Disability; Other.) 

If 'yes'please describe the situation, how you coped/handled it, and how you feel about it now.

.
 

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11.
Have you had any experience with the terminally ill If 'yes'please describe the situation(s) and when it/they occurred.

 

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12.

Besides Englishare you fluent in any other languages (including American Sign Language [ASL])?  If 'yes', please list them, below.

 

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13.
As Solace Hospice Volunteers our aim is to improve the quality of life for our patients and their families.  What does that mean to you?

 

1000 characters left.