Seacoast Hospice and the community that we serve sincerely value our volunteers as partners and through their hands and hearts they embody the true hospice spirit.

Volunteers are selected based on application, interview, and the needs of the organization

An asterisk indicates the information on the form below is required for sending.

Date:*	Primary Area of Interest Office Services Direct Patient Support
1. Personal Information:
Name:*
Street:*
City: *  State:* Zip:*
Email:
Phone: Home* Work Cell
Occupation: D.O.B. (optional):
Please tell us who to contact in case of emergency: Name:  Phone: Relationship: Where to Contact:
2. How did you hear about Seacoast Hospice?
3. Why are you interested in volunteering with Seacoast Hospice?
4. Please List any special training, skills, talents, interests, hobbies, etc. that you have. Include any licenses or certifications that might apply.
5. Do you have any medial or physical limitation that would interfere with your ability to perform volunteer activities? No Yes If yes please explain:
6. Can you make at least a one-year commitment?
7. Is there anything else you would like us to know at this time?
8. Please provide names, complete addresses and contact information of four (2) references who can speak to your ability to volunteer with Seacoast Hospice. Please provide each of your references with one of our reference forms and have them complete and return to you. Please include these with all other required paperwork and mail to the volunteer manager. 1. Name: Street: City:   State: Zip: Email: Phone: Home Work 2. Name: Street: City:   State: Zip: Email: Phone: Home Work
9. Please describe your most significant personal experience(s) with loss, whether from death, illness, accident, relocation, job or role change, or ending of a relationship. Explain how you have resolved your loss and why you now want to help others with their losses. (If you are applying for office Service Volunteering, you may skip this question if you choose.)
10. Which of the following volunteer activities are you interested in? Computer / Data Entry Baking / Cooking Aromatherapy Graphic Design Scrap Booking Bereavement Mailings Gardening Special Events Notary Knitting / Crochet Errands Video / Photography Music / Singing Reiki Committees Painting Spiritual Care Library Staff Tables Vigil Short Notice Visitations Speaking Support Group Facilitator
Please initial here to give Seacoast Hospice permission to verify the information submitted in this application and to contact your references*: Security Code (Please enter the code above)