New Mexico Volunteer Application with Waiver (English)

During which hours are you available for Volunteer Assignments?

Background Information:


Employer: (If retired please document last employer name)
Occupation:
Employer Address:
Employer Phone Number:

Education and/or Special Skills:
Patient and Family Support Volunteer Positions:

In-homeNursing HomeHospital CareErrand Running for PatientRespite (Caregiver Relief and Coverage)Friendly Visit/ CompanionshipMusical TherapyBereavement Support Visit
Non-Patient Care Support Volunteer Positions:

Clerical and Administrative DutiesCrafts and Project OrganizationCommunity Outreach Events/ Special EventsBereavement Program Support Mailer
Please note that a background check and Criminal history check will be conducted if you are in consideration for an opportunity to Volunteer with Tender Care Hospice.
Do you prefer to volunteer to work directly with patients (Patient Centered Care or Non-Patient Centered Duties (Administrative?) and why?
How and where did you learn about our volunteer opportunities?
What do you know about Hospice?
Do you have any fears or concerns about volunteering with someone with a terminal illness?
Have you ever Volunteered with Tender Care Hospice or any other Organizations before? If so, when?
What makes you want to volunteer with Tender Care Hospice? What do you hope to gain from this experience?
Department of Health New Mexico
Department of Health New Mexico
First Name:
Last Name:
Address:
City:
State:
Zip Code:
SSN:
Race:
Gender:
Eye Color:
Hair Color:
Height:
Weight:
US Citizen:
Place of Birth:
Should be Empty:

New Mexico Volunteer Application Form