VOLUNTEER INTEREST FORM
(Fields in
RED
are required.)
VOLUNTEER CONTACT INFORMATION:
Volunteer is:
Adult
Child (under 18)*
Title (Mr., Ms.):
First Name:
Middle Name:
Last Name:
Email:
Address:
City:
State:
Zip/Postal Code:
Daytime Phone:
Ext:
Evening Phone:
Cell Phone:
Employer/School:
Profession:
Areas of specialized training, skills, talents (i.e. carpentry, photography)?
Do you speak a foreign language(s)? If so, please list.
Have you had experience working with someone with ALS?
Yes
No
AFTER READING DESCRIPTONS OF
VOLUNTEER OPPORTUNITIES
, INDICATE BELOW WHICH AREA(S) INTEREST YOU:
Administrative/clerical work in office
Computer-data entry/word processing
Fundraising/special events
Media relations (write press releases, etc.)
Staffing health fairs (daytime hours needed)
Photography (newsletter, events, etc.)
Speaker's Bureau
Grant Writing
Other:
Following is a list of opportunities to volunteer with PALS (Person with ALS):
Phone PALS
PALS assistant at special event
Errands, chores, assist with paperwork, correspondence
Assistive technology/augmentative communication (requires a high level of computer proficiency and expertise)
PALS home companion
Meal prep/delivery
Transportation/delivering equipment to PALS
How often are you interested in volunteering?
Once a week
Twice a month
Once a month
Occassionally
Other:
If you wish to volunteer in any category related to patient assistance, please list the area(s) in South Texas where you would be willing to go:
Please indicate the days and times most convenient for volunteering:
MON
TUES
WED
THURS
FRI
SAT
SUN
Morning
Afternoon
Evening
I prefer contact by:
Phone
E-mail
Snail Mail
* For volunteer applicants under 18 years of age, ONLY:
By clicking on the Submit Volunteer Interest Form button below, you give permission for your child to serve as a volunteer with The ALS Association.
Child Name:
Parent/Guardian Name:
Parent/Guardian Day Phone:
Type your initials here: