Volunteer Application

Volunteer Application

Thank you for your interest in volunteering with Luminary Hospice. We are truly honored to serve our patients and know that we cannot do it without the loving kindness and service from our volunteers. Please reach out if you have questions about this application: ashley.edwards@luminaryhospice.com
Today's Date

MonthDayYear
Date
Name

First NameLast Name
Birth Date (please note that volunteers must be 18 and older)

MonthDayYear
Have you experienced a significant loss in the past 12 months, ie: the death of an immediate family member?
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What area(s) of Columbus or Central Ohio are most convenient for you to travel to in order or visit patients?
How were you referred to us?
If other, please specify:
Which of the following volunteer areas / specialties are you interested in? Check any that apply.

Other
If 'other', please specify:

Please rate your current comfort level with the following, as it relates to interacting with patients:

Rows	Not comfortable and / or not interested	I'm interested, but may lack experience	Very comfortable and / or experienced
Visiting a patient in a facility
Visiting a patient in a private home
Visiting with veterans or participating in veterans' activities
Interacting with a patient's family members / complicated family dynamics
Interacting with patients who are confused or experiencing dementia
Interacting with nonverbal patients / sitting in silence
Sitting vigil / possibly being present at time of death
Communicating with the recently bereaved

Resume*

*Not required for non-licensed applicants
Cancelof
References

Please list two references that are familiar with your work life and/or can attest to your character.
Reference
Reference
I understand that, in order to protect our patients, Luminary Hospice is required to perform a criminal background check, fingerprinting and Tuberculosis testing before I am able to begin visiting with patients (Tuberculosis testing consists of a one-time blood draw).
I certify that the above information is correct.
Thank you for your interest in joining our team of amazing volunteers! Volunteers truly are the heart of hospice and we cannot overstate the impact they have on our patients.

Our Volunteer Coordinator will be in contact soon to schedule a time to meet in person.
Should be Empty: