I, the applicant, understand that Hospice of the Foothills expects a one year commitment to serve a maximum of one 4-hour shift per week. I understand that attendance at monthly Patient Support Volunteer Team Meetings and monthly in-services (continuation training) are important to effective service. I, further understand that it is the policy of Hospice of the Foothills to perform background checks on all volunteers associated with this agency.
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Mailing Address (if different from above)
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What type of direct patient volunteering are you interested in and do you have special skills, degrees or certificates? Would you be willing to include this craft/education in your volunteer experience? Copies of professional degrees or certificates, if applicable will be required.
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Doyouhaveanyphysicallimitations
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If yes, please explain
#1 Person to notify in the event of an emergency:
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Alternate Phone
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#2 Person to notify in the event of an emergency:
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Please list three personal or professional references that you are unrelated to. Complete address is required. #1 Reference:
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#2 Reference:
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#3 Reference:
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Volunteer Experience: Please respond to the following questions as thoughtfully and completely as you can, exploring your feelings and intention. Be certain to cover all the points indicated and respond to each question individually. Do you have previous volunteer experience?
If yes, please describe briefly:
What motivated you to apply for a volunteer position with Hospice of the Foothills?
What do you expect to gain from being a member of Hospice’s Patient Support Volunteer Team?_
What are your feelings about and understanding of pain management?
Because volunteer training is a major commitment of time and effort for both you and our agency, we would like to know if you anticipate anything which may interfere with fulfilling the one year commitment to Hospice of the Foothills, e.g., family obligations, possible plans for relocation, future study, employment?
Have you experienced a significant loss (death, divorce, serious illness) or any other event which has caused you significant stress during the past year? Did you have a role in this process and, if yes, please explain?
Hospice works with people with cancer, AIDS, dementia, as well as other non-cancer diagnoses and prognoses. How would you feel about being with someone who has serious physical limitations or altered appearances resulting from their illness or its treatment?
Volunteers provide emotional and practical support for people experiencing living and dying with a terminal illness. What kinds of patients or situations would you anticipate having the most difficulty with and why?
What is your feeling about working with patients and patient families of a different race, religion, economic and/or spiritual background?
Is there any particular situation in which you would not feel comfortable when working as a Hospice Volunteer?
What is your support system and how do you care for yourself?
Describe your personal experience with grief and your feelings about the grieving process.
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