Aging Services Volunteer Application

Thank you for your interest in volunteering for the Aging Services Department!

Aging Services has several programs that require volunteers. These programs include:

Transportation Program – helping older adults get to essential errand and medical appointments
Home Accessibility and Repair Program (HARP) – assists older adults with minor repairs in the home
Friendly Visitor – provides companionship and socialization to older adults who may be homebound or lonely
Milestones CR or Marion – supports programming needs such as helping with activities, office work, and dining room assistance
Telecare – makes daily calls to homebound clients to monitor their wellbeing

We look forward to working with you and providing exceptional resources for senior citizens in our community together. If you have any questions about this application, please call our office by dialing (319) 398-3647, option 4.

-The Aging Services Team

Abbe Health

An Affiliate of UnityPoint Health

Aging Services and its programs will consider this application without regard to race, color, creed, religion, national origin, gender, sexual orientation, disability, age, marital status, public assistance status, genetic or family medical history, or any other protected classification under local, state or federal law.

Demographics Information

First Name

Last Name

Mailing Address

City

Zip Code

Phone Number

Email Address

Best Way to Contact You

EmailPhone

Best Time to Reach You

MorningAfternoon

Other Information

Emergency Contact

Full Name

Relationship

Phone

Education Background

Highest Level of Education completed

Special Courses or Trainings

Work Experience

Current Employer (if any)

Occupation

Business Phone

May we contact you at work

YesNo

Previous Experience (if any)

Volunteer Experience

Current or Past Volunteer Experience

Other Clubs/Affiliations

Interests/Hobbies/Skills

Programs of Interest

Please select one or more program(s) that you are interested in volunteering with:

References

Please list three references, including one personal and one work/volunteer related:

Reference #1

Name

Address

Phone

Relationship

Reference #2

Name

Address

Phone

Relationship

Reference #3

Name

Address

Phone

Relationship

If you would like to submit a resume, please send it to savanna.snead@unitypoint.org with the subject line “VOLUNTEER RESUME”.

I understand that Aging Services will conduct a criminal background check, motor vehicle record check, adult dependent abuse, and child abuse checks for all volunteer applicants regardless of what is reported on this application. Answering yes to these questions will not be an automatic decline of volunteer status; Aging Services will consider the nature of charges, their relationship to volunteer placement, and the dates involved.

By signing below, I agree that everything in this application is accurate to the best of my knowledge. I authorize the investigation of all statements contained in this application and any supporting documents. I authorize Aging Services and program staff to secure information from the references I have provided, and I release all parties from any liability arising from such investigation. I also agree that I have received Aging Services policies and procedures, signed a Release and Waiver of Liability, and a Confidentiality Agreement.

I agree

Enter your name

Date Signed

I understand that AbbeHealth Aging Services will conduct a check of the Sex Offender Registry. The following signature signifies that you are aware of this check. The National Sex Offender Registry website will be used to check your status.

Should there be a confirmation that you are on this list, you will not be eligible to volunteer.

I agree

Enter your name

Date Signed

I understand that, upon acceptance of my application, it will take up to seven business days to process my application. If my application is accepted, I agree to complete any additional application forms and attend an in-person orientation. If I have any questions, I can contact Aging Services at (319) 398-3647, option 4.

I agree

Enter your name

Date Signed