Care Companion Volunteer Application

Care Companion Volunteer Application

Complete this application to join Care Companions, where volunteers provide non-clinical emotional support, companionship, encouragement, and hope to people navigating cancer treatment.
Contact Information

Tell us how to reach you and where you’re located.
Full Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
About You

Share a little about your background and what brings you to this role.
What best describes your background?

Other
Why do you want to volunteer with Care Companion?
Tell us a little about yourself
Volunteer Experience

Help us understand your experience supporting people affected by cancer.
Volunteer Experience
Experience Supporting Someone With Cancer
Availability

Let us know when you’re typically available to volunteer.
How often are you available to volunteer?

Other
Which days of the week are you usually available?
Preferred time window start

Hour Minutes

AM/PM Option
Volunteer Interests

Select the opportunities that feel like the best fit for you.
Preferred Volunteer Activities

Other
Other Volunteer Activity Details
Hospital Visit Areas

Other
Treatment Center Support Areas

Other
Telephone Support Focus

Other
Virtual Support Focus

Other
Caregiver Support Interests

Other
Survivor Support Interests

Other
Community Outreach Support

Other
Administrative Support Tasks

Other
Health Fair Support Tasks

Other
Background & Training Requirements

To be considered for the Care Companion Program, please confirm that you agree to complete and comply with the following requirements before beginning your volunteer service.
Are you 18 years of age or older?
Background Screening Requirement
Volunteer Orientation Requirement
Confidentiality Requirement
HIPAA and Privacy Training Requirement
Care Companion Program Training Requirement
Emergency Contact

Provide the person we should contact in an emergency.
Emergency Contact Name

First NameMiddle NameLast Name
Relationship to You
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
References

Share the people who can speak to your character and experience.
Reference 1 Full Name

First NameMiddle NameLast Name
Reference 1 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 1 Email Address
example@example.com
Reference 1 Relationship / Organization
Reference 2 Full Name

First NameMiddle NameLast Name
Reference 2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Volunteer Agreement

Please review and accept the terms before submitting your application.
Electronic Signature
Date

MonthDayYear
Date
Should be Empty:

Care Companion Volunteer Application

Contact Information

About You

Volunteer Experience

Availability

Volunteer Interests

Background & Training Requirements

Emergency Contact

References

Volunteer Agreement