Maitri Volunteer Application

Personal and Contact Information
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Your Birthdate*

MonthDayYear
Date
Your Occupation*
How did you hear about Maitri?*

General / Word of mouthConversation with family, friends or colleaguesProfessional recommendationThrough a former resident or staff memberArticle, book or other publicationPrinted flierOnline searchOther
What times on WEEKDAYS are you available?*

Your Physical and Emotional Health
Have you ever had a communicable disease that could now be a potential risk to a person with AIDS?*

YesNo
If "Yes," please describe:
Do you have any condition(s) that puts you at risk for contracting a communicable disease?*

YesNo
If "Yes," please describe:
In the last six months, have you experienced a major life change (e.g., death or other loss, change in job, living situation or relationship, etc.)?*

YesNo
If "Yes," please describe:

Help Us Know You Better
Why do you want to volunteer at Maitri?*
Describe your personal experiences with death, grief, and any feelings you may have about the grieving process.*
Anything else you would like us to know?

We appreciate the time and thought involved in completing this application. Thank you for your interest and support. If you have questions, please feel free to email our Volunteer Coordinator, David Valentine, at dvalentine@maitrisf.org.
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