Scott's House Volunteer Form

Volunteer Form

Thank you for your interest in becoming a community hospice volunteer. Please fill out and submit the form below and we’ll be in contact soon.

Volunteer Form

To become a community hospice volunteer, please fill out this volunteer form. All information submitted on this form will remain confidential and is encrypted. If you’d prefer to print this form out and mail it, please click here.

Mailing address is: 287 Rodeo Road, Santa Fe, NM 87505

If you prefer to provide your SSN and Drivers Licence # to us at a later date, please leave those fields empty on the form.

Name

Phone

Mailing Address

City

State

ZIP

Social Security Number

Driver's License Number

Do you have any professional or volunteer experiences with a hospice patient?

Yes No

If so, what experience?

Do you have any professional or volunteer caregiving experiences?

Yes No

If so, what experience?

Have you ever participated in a hospice care volunteer training?

Yes No

Do you have any health issues?

In your own words, state your understanding of ethical responsibilities regarding your work with health services clients.

Indicate the time commitment you feel you can make to your volunteer activity.

List your history of volunteer participation, giving the following for each and all involvements: (Add supplemental pages to provide this information or list below)

List volunteer history if you have no files to upload.

Agency or organization where you served:

Type of service you performed and level of your responsibility (individual volunteer, volunteer team leader, supervisor, etc.)

Length of involvement (# of months, etc.) and frequency of involvement (# times per month, etc.)

Provide a reference person that we can contact regarding your volunteer activity in that organization

I hereby authorize Scott’s House, Inc. to check my references and do a FBI criminal background check

Type out your full legal name:

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Volunteer Form

Volunteer Form

Scott's House is a 3 bedroom, 3,000 square foot home located on Santa Fe's east side. We are currently raising money to pay off the mortgage and for operating funds.

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Legal

Contact

287 Rodeo Road
Santa Fe, NM 87505

505 204 5696

info@scottshouse.org

Follow us on Facebook:

Volunteer Form

Volunteer Form

Scott's House is a 3 bedroom, 3,000 square foot home located on Santa Fe's east side. We are currently raising money to pay off the mortgage and for operating funds.

Navigation

Legal

Contact

287 Rodeo Road Santa Fe, NM 87505

505 204 5696

info@scottshouse.org

287 Rodeo Road
Santa Fe, NM 87505