ReMend Volunteer Application

VOLUNTEER APPLICATION

Thank you for your interest in becoming a ReMend Mentor. ReMend Mentors can make a huge impact in the lives of new and continued dialysis patients, in addition to those considering a change of therapy. If you’re interested in becoming a ReMend Volunteer, please complete the application below.
Your Full Name*

First NameLast Name
Your E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate

MonthDayYear
Best days/times to reach you? Weekday Afternoon, Weekend Morning etc.
Are you currently employed? If so, please list your current employer & title along with your previous employer and title.
List any special training and/or skills.
What Language(s) do you speak other than English? Please list language and if spoken, or written and if excellent, good, fair or poor.
Community Involvement
Please list community organizations in which you are currently involved:
Please list your volunteer experience along with dates:
Tell Us A Little More About Yourself
Tell us about your kidney journey. You could share what it was like when you learned your diagnosis, was your treatment difficult, have you been transplanted, are you a living donor?*
If you've had a kidney transplant, what is the date you received your kidney?
How did you learn about ReMend?
Please list 2 references - other than a relative. Provide name, phone and best time to contact:
If I am accepted as a ReMend Volunteer, I agree not to discuss or divulge, outside of my ReMend duties, names, addresses or other information relative to individuals or families who contact ReMend, unless I have specific written authorization from the client. I also agree that in the course of my ReMend duties I will not promote or endorse any business with which I am affiliated.
Signature*

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VOLUNTEER APPLICATION

Community Involvement

Tell Us A Little More About Yourself