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Direct Care volunteers
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Meet Our Volunteers
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Volunteer Application

Many thanks to the volunteers who have gone above and beyond to support our patients during the coronavirus crisis

Questions? Contact our Volunteer Services Director Craig Schroeder at 650.532.2323 or by email.

Upcoming volunteer information sessions (San Mateo or online – TBD)

Tuesday, February 8, 2022, 12-1pm and 5:30-6:30pm

Upcoming volunteer training dates (VIRTUAL)

February 17 – March 12, 2022

For more information, contact Volunteer Services Director Craig Schroeder at 650.532.2323 or by email.

Volunteer Application

Step 1 of 5

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Personal Information
Name*
First Last
Home Address*
Street Address Address Line 2 City State ZIP Code
Email*
Date of Birth*
Primary Phone*
Cell Phone
Home Phone
Work Phone
Occupation*
If retired, former Occupation
I am interested in becoming a*
- Direct care volunteer (with patients and families)
- Indirect care volunteer (support in the office and at events)
Emergency Contact
Emergency Contact Name*
First Last
Emergency Contact Phone*
Emergency Contact Email

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Education*
Professional training*
Hobbies and interests*
Skills*
- Computer
- Fund solicitation
- Typing / data entry
- Public speaking
- Telephone/reception
- Mailings
- Statistical data & recordkeeping
- Other
Other:*
What languages do you speak?*
Do you have a valid driver’s license, a car, and current auto insurance?*
- Yes
- No
Are you a veteran?*
- Yes
- No
Which branch?*

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Background
What is your volunteer experience?*
Please list any other community organizations with which you are currently involved:*
Please tell us why you are interested in volunteering with terminally ill patients and their families.*
Have you experienced a significant loss or traumatic event in the past year? If yes, please explain.*
What support system do you have to help with stressful circumstances?*
Do you have any physical/health limitations or allergies that should be considered? Please explain.*

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Availability
Monday
- Morning
- Afternoon
- Evening
Tuesday
- Morning
- Afternoon
- Evening
Wednesday
- Morning
- Afternoon
- Evening
Thursday
- Morning
- Afternoon
- Evening
Friday
- Morning
- Afternoon
- Evening
Saturday
- Morning
- Afternoon
- Evening
Sunday
- Morning
- Afternoon
- Evening
References
List two references who are not relatives and who have known you for at least a year.
Row Start
Name*
Relationship*
Phone*
Column Break
Name*
Relationship*
Phone*
Row End

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Other
How did you hear about volunteering with Mission Hospice & Home Care?*
- Newspaper, newsletter, or flier
- Online
- Fair or event
- Word of mouth
Where?*
Which One?*
Who?*
Signature & Submission
Signature*
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Peninsula office66 Bovet RoadSuite 100, San Mateo, CA 94402, 650.554.1000
South Bay office1688 Willow StreetSuite A-2, San Jose, CA 95125, 408.554.2434
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