Volunteer Application

Volunteer Application

Volunteer Programs at Mystic Valley Elder Services offer meaningful ways to connect with your community. We provide a variety of opportunities for you to share your time, skills, and knowledge in service to others. Adults of all ages and abilities are welcome to join us in celebrating community, promoting independence, and fostering compassion.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

City/TownState / Province

Postal / Zip Code
Employer
Birthdate*

MonthDayYear
Date
Gender Identity*

MaleFemaleTransgenderNon-BinaryDecline to answerOther
Gender Identity Other
Primary Language Spoken*

EnglishArabicCantoneseMandarinHaitian-CreolePortugueseRussianSpanishOther
Primary Language Spoken Other
Additional Languages Spoken (check all that apply)*

EnglishArabicCantoneseMandarinHaitian-CreolePortugueseRussianSpanishNoneOther
Additional Languages Spoken Other
Race/Ethnicity (check all that apply)*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Pacific IslanderMiddle Eastern or North AfricanDecline to AnswerWhiteOther
Race/Ethnicity Other
How did you learn about our volunteer programs?

WebsiteFamily/FriendNewspaperFacebookInstagramLinked InOther
How did you learn about our volunteer programs Other
Geographic Preference (check all that apply)*

No PreferenceChelseaEverettMaldenMedfordMelroseNorth ReadingReadingRevereStonehamWakefieldWinthrop
Volunteer Opportunities
- Money Management Bill Payer - Assist older adults and adults with disabilities with budgeting and bill paying tasks
- Technology Access Trainer - Bridge the technology divide by teaching how to use digital devices to enhance their ability to stay connected.
- Healthy Aging Workshop Leaders - Co-Facilitate multi session evidence-based workshops to promote health and wellbeing.
- Meal Site Assistant - Help serve and organize meals at one of our congregate dining sites
- Ensure Program Driver - Deliver Ensure Nutrition shakes to homebound consumers
- SHINE Counselors - Serving the Health Insurance Needs of Everyone (SHINE) counselors provide health insurance and health benefits information, counseling, and assistance for Medicare recipients and those approaching Medicare eligibility
- Office Support & Special Projects - Assist with various office projects and tasks, such as preparing envelopes and mailers.
Volunteer Interest - First Choice*
Volunteer Interest - Second Choice
Volunteer Interest - Third Choice
What skills, hobbies, and/or interests do you have that you believe could contribute to your role as a volunteer? How would you like to use them to make an impact?*
References (non-family members)

Money Management Volunteers require three references
Name*
Relationship*
Phone*
Email*
example@example.com
Name
Relationship
Phone
Email
example@example.com
Name
Relationship
Phone
Email
example@example.com
Emergency Contact Information
Emergency Contact Name*
Emergency Contact Relationship*
Emergency Contact Phone*
Please enter a valid phone number.
Emergency Contact Email
example@example.com
Resume (optional)- Word or PDF Only

Cancelof
Confidentiality and Conflict of Interest Statements*

I will observe the confidential nature of all information given to me during the course of my volunteer service at MVES and will follow all policies in accordance with the Federal Health Insurance Portability and Accountability Act (HIPAA) and the Written Information Security Program (WISP).I certify that my volunteer services at Mystic Valley Elder Services is not a conflict of interest. Neither I nor members of my immediate family have a financial or other interest in Mystic Valley Elder Services, nor in any of the subcontractors or other providers. If this situation should change, I will notify Mystic Valley Elder Services, in writing, and identify such potential conflict of interest.I understand that as a Mystic Valley Elder Services volunteer, I am not paid for my services.I certify that the information contained in this application is correct in the best of my knowledge, and I understand that falsification of this information is grounds for my dismissal.
Would you like to subscribe to our e-newsletter The Beacon to stay up to date on MVES programs and opportunities?*

YesNo
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Date*

MonthDayYear
Date
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Volunteer Application

References (non-family members)

Emergency Contact Information