Become a Volunteer at Hospice Visions

First Name

Middle Name

Last Name

Address

City

State

Zip Code

Email Address

Phone Number

Company

Address

Position

Company

Address

Position

Company

Address

Position

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

What is your area of interest? Please check all that apply:
Patient Care
Clerical Support
Other

When are you able to provide your volunteer service? Please check all that apply:
Days
Evenings
Weekends
Flexible

Why are you interested in volunteering for Hospice Visions?

What qualities do you possess and volunteer experience have you had that would make you a good volunteer?

Are you a veteran or the family member of a veteran? If so, which branch of service were you or your family member in and in which era did you or your family member serve?

How were you introduced to Hospice VSisions, LLC.?

What prompted your interest in hospice?

Background (education):

When and what has been your experience with death, grief, and loss?

What would you like to gain by volunteering?

Please list any interests and hobbies

What other volunteer experience have you had?

Explain how you would respond to the following situations:

Situation #1:
You have been assigned to visit a hospice patient to provide encouragement and comfort. When you arrive, the family thanks you for coming, but the patient yells at you, "I don't need any of your sympathy! Get out of here!"

Situation #2:
As a hospice volunteer you visit Frank, who has cancer. After each visit, he asks you when you will return and always begs you to come back more often than you have been assigned by hospice and have agreed to serve.

Situation #3:
When you go to visit an assigned patient as a hospice volunteer, the patient asks you why hospice has not delivered the hospital bed that he requested. He has been waiting three weeks for the bed and says he cannot sleep another night on his current bed. It is 8:00 pm on a Friday when you make this visit.

Consent

I authorize Hospice Visions to contact employers, references provided, and gather other appropriate information to determine my character, work habits, and eligibility to become a hospice volunteer.