Online Volunteer Application:

Please complete and submit this form or contact the following people if you are interested in becoming a Delaware Hospice volunteer or would like more information:

Marguerite Werner - volunteerwilmington@delawarehospice.org
In Wilmington (302) 478-5707 x127

Judy Knutstad - volunteerdover@delawarehospice.org
In Dover (302) 678-4444 x117

Mary Costello - volunteergeorgetown@delawarehospice.org
In Georgetown (302) 856-7717 x120

Volunteer Application

Required fields are marked with a * Check the office location nearest you:

Wilmington Office
3515 Silverside Rd.
Wilmington, DE 19810
(302) 478-5707
Fax: (302) 479-2586

Dover Office
911 South DuPont Highway
Dover, DE 19901
(302) 678-4444
Fax: (302) 678-4451

Georgetown Office
20167 Office Circle
Georgetown, DE 19947
(302) 856-7717
Fax: (302) 855-2345

* Last Name:

* First Name:

MI:

Nickname:

* Home Phone:

Work Phone:
Cell Phone:

* Address:

Apt. #

* City:

* State

* Zip:

Email Address:

Emergency Contact Name & Relationship:

Telephone Number:

Employment, Education and Volunteer Experience

* Are you currently employed? Full Time Part Time Retired

Occupation:

Employer Name (Current or Previous):

Last Grade Completed:
High School:	9	10	11	12
College:	1	2	3	4	More
College Major:

Have you previously served as a volunteer? Yes No
If yes, with whom:

Description of Service:

Please Check Your Skills and Preferences

Helping Patient/Caregivers in the Home

Helping Patient in Nursing Home

Community Events/Marketing

Public Speaking/Motivational Speaking

Mailings/Special Projects

Filing/Medical Records

Computer Skills/Data Entry

Errands/Transportation

Fundraising

Working with bereaved children

Availability

Please check the boxes below for the days and times you are most often available to volunteer.

Time of Day

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Morning

Afternoon

Evening

How did you hear about our Volunteer Program?

Reason for Volunteering with Delaware Hospice:

Personal Reference:

Name:
Address:
Phone:
Relationship:

OUR MISSION: Delaware Hospice is committed to being the leader in providing high-quality hospice and palliative care to individuals with a limited life expectancy, their families and caregivers, and to serve the community as a resource for end-of-life care.

Thank you for your interest in the Delaware Hospice Volunteer Program!

> Share the Gift
> Volunteer Application

Delaware Hospice is accredited by JCAHO. Read Statement