Volunteer Caregiving Application

Volunteer Caregiving Application
Name*

First NameLast Name
Pronouns*
E-mail*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Birthdate*

MonthDayYear
Record Type Id

More About You

As you answer the essay questions, please pause and reflect deeply on the questions before filling it out in order to give us the fullest picture of who you are.
1. What is your cultural identification?*
2. If you speak a foreign language, please list them.*
3. How did you hear about our volunteer program?*
4. I’m interested in being a volunteer caregiver at:*
5. Please describe any experience you have had in your personal life—either yourself or someone close to you—with addiction, mental health, or homelessness.
Volunteers for the Cadillac will encounter people with addiction and mental health issues.
6. Are you presently working/studying?*
7. What is your occupation/course of study?*
8. Time(s) I'm available to volunteer*

Weekday - morningWeekday - afternoonWeekday - evening
Our caregiver volunteers serve in one of the three shifts on weekdays: mornings (9 am - 2 pm), afternoons (1 pm - 6 pm), or evenings (5 pm - 10 pm).
9. Zen Caregiving Project encourages its volunteers to have a spiritual/meditation practice. Please describe your spiritual/meditation practice, if any.*
10. Please describe any personal experience with serious illness (your own or that of someone close to you), and its effect on you.*
11. Have you spent time with someone very sick and/or dying?*
11. Have you recently experienced a loss through death?*
12. Have you ever seen a dead body?*

YesNo
13. Have you ever attended a funeral?*

YesNo

Volunteer Experience

Please be specific and include as many details as you can.
14. Do you have any prior volunteer experience?*
15. What do you look for in a volunteer experience?*
16. Why have you chosen Zen Caregiving Project over other volunteer opportunities?*
17. What is your understanding of hospice?*
18. How do you see your role as a palliative care volunteer?*
19. Our volunteers work with people with cancers, AIDS, dementia, as well as other illnesses and concerns. Describe your feelings about what it may be like for you to be with people with serious physical limitations or altered appearances resulting from their illnesses or treatments.*
20. Our volunteers provide emotional and practical support for people experiencing living and dying with a chronic or terminal illness. What kind of patients or situations do you anticipate having the most difficulty working with and why?*
21. Describe your personal experience with grief and your feelings about the grieving process.*
22. It's important for caregivers to have good emotional support in their own lives. What are sources of emotional support for you?*
23. Do you anticipate anything which may interfere with fulfilling the one-year commitment to Zen Caregiving Project, e.g., family obligations, possible plans for relocation, future study, etc?*
24. How would you describe your general health?*
25. Please describe any allergies you have.*
26. Do you have any specific physical limitations we should be aware of?*
27. How do you feel about the time & energy required to volunteer with Zen Caregiving Project?*
28. Are there any additional thoughts that come up for you in completing this application, or anything else you would like us to know?*
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Volunteer Caregiving Application

More About You

Volunteer Experience