Become a Volunteer

Volunteers are an integral part of our hospice team, filling roles that range from direct contact with patients to providing clerical and phone call support for the organization. Hospice volunteers describe their work as gratifying, intellectually stimulating, and emotionally meaningful. Hospices require a lot from their volunteers and value them greatly.

To apply, fill out the form below.

Weinstein Hospice Volunteer Form

Please complete the application as fully as possible to help us help you, thank you!

Name*
First Last Prefer to be called
Date of Birth*
MM slash DD slash YYYY
Age*
Have you been vaccinated against COVID-19?*
Please upload front and back of your COVID-19 vaccine card.
Drop files here or

Accepted file types: jpg, gif, png, pdf, heic, Max. file size: 1 GB.
If you prefer to submit your COVID-19 proof of vaccination using another method please click yes.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Contact Information
Home Number
Work Number
Cell Number*
Fax Number
Email*
Emergency Contacts:
Emergency Contact Name 1*
First Last Relationship
Primary Phone Number*
Secondary Phone Number
Emergency Contact Name 2*
First Last Relationship
Primary Phone Number*
Secondary Phone Number
Personal Information
Are you a student?
If yes, where do you attend school?
Is your interest in volunteering part of a school community service requirement?
Present occupation or retired
Employer
Other work experience
Education level reached
Special skills, interests, or hobbies
What languages do you speak?
Physical limitations
Current and previous volunteer experience
Religious identification & synagogue or church affiliation
Observances important to you: (ex,. keeping kosher; Shabbat; religious or family special days)
How did you hear about the Weinstein Hospice volunteer program?
What was your last personal experience with death? (Please relate the relationship to you, when they died, and the circumstances of the death.)
Why do you want to work with hospice?*
I would be interested in work that involved*
- direct involvement with patient and family
- administrative support in the hospice office
- telephoning or working from my home
- special events and/or community education
What do you hope to gain from the experience of working or volunteering at Weinstein Hospice?
References: (Please list persons from school, church, synagogue, employment, or past volunteering. Do not use family members or close friends.)
Reference Name 1*
First Last Relationship
Address
City, State, Zip Code
Home Number
Cell Phone*
Email*
Reference Name 2*
First Last Relationship
Address
City, State, Zip Code
Home Number
Cell Phone*
Email*
I understand that the information provided in this application to volunteer with Weinstein Hospice is part of the volunteer permanent file. This information will be kept confidential and only be used to assist Weinstein Hospice in completing its volunteer screening process and in making the best possible match between me and a patient and/or assignment with the hospice.

I also understand that if I am accepted as a volunteer, I am committed to attending volunteer education and training sessions provided by the hospice and to abiding by the Policies and Standards of Practice of Weinstein Hospice.

I hereby certify that all information included in this application form is true and complete. I give permission to an authorized hospice representative to conduct reference checks with the above named referees and to submit my name for a criminal history background check with the state of Georgia.
Type your name to verify you understand conditions above*

Type your name to verify you understand conditions above
Date*
MM slash DD slash YYYY

Date
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