Thank you for your interest in volunteering with Senior Services!

Senior Services relies heavily on a dedicated team of community volunteers to help carry out our mission.

Please complete this secure online volunteer application to get started!

Contact and Personal Information

Please tell us a little about yourself!

Please select a salutation: *

First Name *

Middle Name *

Last Name *

Preferred Name/Nick Name (if applicable):

Please select a gender: * 🛈

Current Street Address *

Address Line 2

City *

State *

Zip Code *

Please enter your start and end dates at your current address:

From Month *

From Year *

To Month *

To Year *

How many years at this address? *

Less than 1 year

More than 1 year

Previous Street Address *

Previous Address Line 2

Previous City *

Previous State *

Previous Zip Code *

How long did you live at this address?

From Month *

From Year *

To Month *

To Year *

Cell Phone Number *

Alternate Phone Number (Optional)

Email Address *

Volunteer's Date of Birth: * +

What is your preferred method of contact? *

Phone call

Email

Would you like to stay connected with ways to support our organization? *

Yes

No

Are you affiliated with a civic, corporate, or faith-based organization or group? *

No

Yes, which one(s)? Yes, which one(s)?

I am currently: * 🛈

Employed

Retired

A Student

Other: Other:

By completing this application, I am seeking: *

A volunteer opportunity

An internship

To complete a class service requirement

Please list your employer? *

Please identify which school? *

Have you ever been convicted of a crime? *

No

Yes, please describe: Yes, please describe:

Intern and School Requirements

Please indicate which class/major you are completing this requirement for: *

Advisor/Instructor Name (First and Last) *

Advisor/Instructor Title or Position *

Advisor/Instructor Email Address *

Advisor/Instructor Phone Number *

Let us know your specific academic requirements and when you're available to join us!

How many hours of service do you need to complete? * 🛈

When are you available to start? * +

What length of time are you looking to volunteer/intern? *

Please indicate any specific tasks or goals you need to complete or experience during your internship. Please be as detailed as possible.

Examples may include observe and assist an RN, plan and lead an activity, work directly with a participant, complete a special project, etc. *

Does your program require a person with a specific degree or professional credentials to provide supervision? *

No

Yes (please indicate below): Yes (please indicate below):

Is there a specific Senior Services program you're interested in interning with? *

Emergency Contact

Please let us know who we should contact in the event of an emergency.

Please select a salutation *

Emergency Contact First Name *

Emergency Contact Last Name *

Phone Number *

Relationship to Volunteer *

Availability and Preferences

Let us know when you're available to volunteer and what you'd most like to do!

Are you interested in volunteering with any of the following programs? Please check all that apply. *

Meals-on-Wheels (weekdays between 9:45am-12:00noon)

Lawn Care (Lawns of Love)

Office and Administration

Speaker's Bureau/Agency Ambassador

Opening Minds Through Arts (OMA)

Assist with Technology

Williams Adult Day Center

Do you own/can you transport your own lawn maintenance equipment (mower, weed eater, etc.)? *

Yes

No

Are you volunteering with someone else? *

No

Yes. Please give their name: Yes. Please give their name:

When are you available to volunteer? (Check all that apply) *

Please indicate the best time of day for you to volunteer *

How many days each month are you available to volunteer? *

Do you have a geographic preference for volunteering? *

Please review the below list and select/share any special skills, hobbies and interests that you have (mark all that apply): *

You indicated that you are bilingual. Please tell us which language(s) you are able to speak: *

How did you hear about Senior Services? Please check all that apply. *

Please indicate which college/university website or event you heard about us from.

Please indicate which social media platform you heard about us on.

Please indicate the other website(s) where you heard about Senior Services.

Volunteer Match

HandsOn NWNC

Love out Loud

Other: Other:

Please indicate the community event where you heard about Senior Services.

Please indicate the place of worship where you heard about Senior Services.

Background Screening Consent Form

Senior Services may obtain from Sterling Volunteers, 113 South College Avenue, Fort Collins, CO, 80524, (855) 326-1860. www.sterlingvolunteers.com, a consumer report and/or an investigative consumer report that contains background information about you in connection with volunteerism. Sterling Volunteers may obtain further reports throughout your volunteerism so as to update your report without providing further disclosure or obtaining additional consent.
The background report may contain information about your character, general reputation, personal characteristics and mode of living. The background report may include, but is not limited to, credit reports and credit history information; criminal and other public records and history; public court records; motor vehicle and driving records; and Social Security verification and address history, subject to any limitations imposed by applicable federal and state law. This information may be obtained from public record and private sources, including credit bureaus, government agencies and judicial records, and other sources. If an investigative consumer REPORT is obtained, in addition to the description above, the nature and scope of any such REPORT will be for personal references.
I have read the Disclosure above regarding Volunteer Background Report provided by Senior Services and this Authorization to Obtain Volunteer Background Report. By my signature below, I hereby consent to the preparation by Sterling Volunteers, a consumer reporting agency located at 113 South College Avenue, Fort Collins, CO, 80524, (855) 326-1860,www.sterlingvolunteers.com, of background reports regarding me and the release of such reports to Senior Services, to assist the Senior Services in making a volunteer decision involving me at any time after receipt of this authorization and throughout my volunteerism, to the extent permitted by law. To this end, I hereby authorize, without reservation, any state or federal law enforcement agency or court, educational institution, motor vehicle record agency, credit bureau or other information service bureau or data repository, to furnish any and all information regarding me to Sterling Volunteers and/or Senior Services itself, and authorize Sterling Volunteers to provide such information to Senior Services. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original. I acknowledge receipt of a copy of the Consumer Financial Protection Bureau’s “A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT.

Volunteer's signature *

clear

Thank you for your interest in volunteering with Senior Services, Inc.!

The next step once you finish this application is to complete the orientation. A pop up box will give you the link once this application is submitted.

If you have any questions, please contact:

Tyler Smith, Volunteer and Community Relations Coordinator

tsmith@seniorservicesinc.org or

336-721-6961.

Acting	Art	Bilingual
Carpentry	Crafts	Dance
Data Analysis	Data Entry	Event Planning
Filing/Sorting/Organizing	Gardening	Handy Person/Fix It Skills
Interpersonal Skills	Microsoft Office/Excel	Music
Outdoor/Yardwork	Photography	Play Instrument
Public Speaking	Reception	Singing
Teaching/Facilitation	Training	Video Production
Other: Other: