Volunteer Form Volunteer Application Form Step 1 of 3 33% About YouName* First Last If you are part of an organization please enter it here:Address* Street Address City State / Province / Region ZIP / Postal Code Daytime Phone*Cell PhoneEmail* Areas of Interest or CertificationI am a...College/Vocational StudentHigh School/Elementary School StudentCurrently attendingChoose oneUniversityCollegeJunior CollegeProfessional SchoolName of SchoolAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country I am enrolled in a program focusing onChoose oneComputer ScienceNursingOccupational TherapyPhysical TherapyRecreation Therapy/ManagementSenior CareHow many hours a week are you requesting to volunteer?This volunteer experienceChoose oneFulfills an internship requirement for graduationObserve for my application for college admittanceComplete an assignment for my educationProvide a chance to learn more about a potential career for meName of school you are attendingAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country I am seeking volunteer opportunities to fulfill (choose one)Service hours for high school graduationService hours for confirmation or other religious ceremonyA life enrichment program from my className and location of churchName of moderator or teacher Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last I am 18 years-old or younger and understand I must have my parent or guardian sign a "Consent for Minor" form to be provided during orientation. Volunteer InterestsI have a therapy dog that I am interested in having volunteer with meYesNoName of dogBreedWeight of dogAge of dogDate of dog therapy certification My dog was certified byTherapy Dogs InternationalTherapy Dogs, Inc.Please include the city and state of certification if it is "other"I learned about this volunteer opportunity from: Resident Neighbor A group in which I'm involved Publicity Staff member Have you ever applied for employment at a Smith Senior Living Community?YesNoHave you ever been employed by a Smith Senior Living Community?YesNoI would like to volunteer at:Smith VillageSmith CrossingI am interested in volunteering because:The choices listed here are volunteer opportunities available at both Smith campuses. Your preferences will be discussed with you fully at your required orientation.Opportunities1 Day EventActivitiesBoard and card gamesBook clubComputer SkillsCrocheting, KnittingConversational SpanishDance LessonsGardeningHistory DiscussionsLibrary CartMusicals Discussion1-day seasonal landscape clean upOrientationPainting classesPet therapyPhotographyPoetry ReadingTheater GroupTrainingTransportation within the communityVisit with residentsWalkingFitness/exerciseMisc.Laundry ServicePhysical TherapyReligious servicesDietaryEntertainmentDining ServicesJournaling VisitsGift ShopHelp resident with unpackingDriver ProgramMarketingSewing ClubReceptionistHorticulture TherapySalon AssistanceTrip AssistanceMail DeliveryInternshipCPR ClassManicuresCooking GroupDiscussion GroupService ProjectSeasonal LandscapingOffice/Clerical DutiesArts and CraftsNewspaper DeliveryLibrary AssistanceIntergenerationalSeasonal DecoratingCaroling throughout the communityDance PerformanceAudio/Visual AssistanceResident Services AssistanceEVS AssistanceHuman Resources AssistanceEmilie's Fund FundraiserNursing Student InterviewsCoffee & ConversationWheelchair clearingGift WrappingWriter's GroupLPN Student ClinicalsHern & StitchSaint Xavier Renaissance AcademyHoliday PresentationHome OrganizationShort Story Discussion GroupCommunity WellnessBAPA AssistanceSpecial Skills, Hobbies and InterestsOther Volunteer ExperienceI prefer to volunteer with the community of residents in Independent Living Assisted Living Alz/Memory Support Skilled Nursing Schedule PreferencesI would prefer to volunteer Once only Once a week Once a month As needed Day of the week Sunday Monday Tuesday Wednesday Thursday Friday Saturday Time of day Morning Afternoon Evening *In order to be a volunteer, I understand that attending orientation is mandatory and, based on my volunteer assignment, some additional training may be provided. I am also aware that before I begin volunteering I will be required to comply with Smith Senior Living’s policy to take a TB screening test, a security background check and a drug screening test. I understand that Smith Senior Living will pay for the costs of these tests. Untitled
Volunteer Form