Volunteer Application Form

PERSONAL INFORMATION

Full Name

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Date of Birth

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Preferred Method of Contact

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Preferred Method of contact - *Other*

How did you hear about volunteering for LifeCare Alliance?*

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Emergency Contact

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VOLUNTEER PREFERENCES

Position for which you are volunteering:

Meals on Wheels Delivery

Weekdays Pick-up meals in your neighborhood and deliver to your homebound neighbors.

Weekends Pick meals up from drop-off sites in Dublin, Gahanna or LifeCare Alliance, and deliver to those who are homebound. Scheduling is arranged for weekday or weekend delivery opportunities based upon availability.

Holidays Deliver meals to homebound neighbors on the following holidays: Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Eve, New Year’s Day, Martin Luther King Day, Memorial Day, Fourth of July and Labor Day. Meals-bag pick-up and drop-off conducted at 670 Harmon Avenue for all holiday routes.

Time Requirement: 1-2 hours.

Senior Dining Centers

Dining Center Program Aide Assist the Dining Center Coordinator with all duties before, during and after dining center meal service. Set-up: Arrange tables; set out salt and pepper shakers, napkins, and centerpieces.

Registrar Register participants; keep attendance sheet; take reservations for the next meal served.

Greeter Welcome participants as they come into the dining center; be friendly and polite; encourage socialization among dining center participants.

Serve Meals Assist with trays, tables, meal line, orders, and beverage stations. Clean-up: Collect meal carrier bag(s); wipe off tables and counters; clean coffee pots; sweep floors; arrange chairs; dispose of trash. With the assistance of the DC Coordinator: plan, schedule and implement activities, crafts, entertainment, etc.

Time Requirement: Weekdays, 9 am-3 pm. Ongoing weekly or monthly service to be negotiated with Dining Center Coordinator as necessary.

Wellness Center Office Assistant

Assist with Wellness Center office tasks as assigned by Wellness Center Nurses. Greet clients. Answer telephone calls, take messages accurately and legibly. Maintain appointment book and orderly volunteer desk area. Perform clerical and non-specific duties as requested by the nurse. Volunteer must have unimpaired hearing and vision and ability to maintain professional confidentiality.

Time Requirement: Negotiable based upon availability of both volunteer and agency, Monday - Friday.

LifeCare Alliance Office Assistant

Assist with daily administrative tasks of the LifeCare Alliance Mound Street and Harmon Avenue offices. Tasks include (but are not limited to): filing, database entry, packet and agency literature assembly, phone calls, volunteer-hour tabulation and mailing assistance. Opportunities are available within various LifeCare Alliance program departments, but subject to project availability.

Time Requirement: Negotiable based upon availability of both volunteer and agency, Monday - Friday.

POHC Office Specialist

Support Project OpenHand-Columbus by proving clerical assistance to the Program Coordinator. Answer telephones, take messages, schedule pantry orders. Use the computer database to enter, update and/or confirm client information. Make copies and file client information and folders. Help drivers organize daily deliveries. Prepare food pantry orders as needed. Previous clerical experience preferred.

Time Requirement: At least one day of service per week, during pantry hours: 9:00a.m. - 2:00p.m., Monday - Friday.

Columbus Cancer Clinic

CCC Mammography Assistant Ensure that procedures for greeting, check-in and clerical/administrative duties flow smoothly, in order to deliver the most pleasant experience possible for mammography clients, both in-office and pertaining to mobile units.

Mobile Mammography Activities Greet clients upon arrival. Assist clients with check-in procedures. Review pre-registration forms and insurance cards for completeness and accuracy; receive payments, issue receipts and keep accurate records of payments. Provide instructions to clients in preparation for the examination. Monitor client flow in an effort to keep appointments on schedule.

Clinic Mammography Activities Pull mammography charts of previous/current Clinic clients for the next week’s scheduled appointments. Prepare mammography charts for new patients with upcoming appointments. File old charts and mammogram reports. Volunteer must demonstrate good organizational and time management skills and maintain client confidentiality.

CCC Wigs & Prostheses Assistant Provide clients with a variety of well-kept wigs and prostheses. Duties include washing wigs and prostheses; styling wigs, creating an inventory system and taking inventory. Volunteer must have the ability to interact effectively with staff and patients, be comfortable and compassionate about cancer and other health-related issues, and maintain client confidentiality.

Time Requirement: Negotiable based upon availability of both volunteer and agency.

Meals-on-Wheels Kitchen

Groups and/or Individuals

Assist LifeCare Alliance kitchen staff with tasks necessary to keep Meals-on-Wheels program running smoothly. Duties range from seated tasks (i.e., condiment inventory, ‘blizzard box’ assembly, etc.) to foot-work (plating meals, packing meals, disposing of meal-bag liners, wiping bags down after delivery, storing bags until next use, etc.).

Location: 1699 W. Mound St. or 670 Harmon Avenue

Time Requirement: Different groups and/or individuals daily

Groceries-to-Go Food Pantry Driver

Provide groceries to homebound patients living with cancer or HIV/AIDS. Pick up bags of groceries up at the Harmon Avenue Groceries-to-Go facility. Deliver groceries to assigned patients’ homes.

Time Requirement: Negotiable based upon availability of both volunteer and agency.

Groceries-to-Go Food Pantry Assistant

Assist with keeping food pantry running smoothly—includes variety of administrative, bagging, stocking and distribution tasks. Stock new inventory on shelves, rotating older inventory to the front of the shelf for distribution. Organize and stock inventory according to categories (fruits, vegetables, pasta etc.). Bag grocery orders for pick-up. Distribute orders to clients that come to collect filled orders. Notify appropriate program personnel of drop-in requests. Maintain that the pantry is in safe working order by disposing of trash and unneeded cartons in the dumpster.

Time Requirement: Negotiable based upon availability of both volunteer and agency; pantry hours: 9:00am - 2:00pm, Monday - Friday.

Availability

What day(s) do you prefer to volunteer?

What holiday(s) do you prefer to volunteer?

References (For Meals-on-Wheels Volunteers)

Reference 1

references 1 - Email

Reference 2

references 2 - Email

Name

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Volunteer