Volunteer Application – Delaware Hospice

Please select the location where you would like to volunteer.*

Newark Office
Dover Office
Milford
Pennsylvania Office

Volunteer Information

Delaware Hospice provides the highest quality hospice and health care services, and serves as a trusted community partner in end-of-life education and support. Thank you for your interest in the Delaware Hospice Volunteer Program!

Name*

First Last

Nickname

Home Phone*

Cell Phone

Work Phone

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Emergency Contact Name*

First Last

Relationship*

Phone Number*

Employment, Education, and Volunteer Experience

Employer Name (current or previous)*

Occupation/Title*

Are you currently employed?*

Full Time
Part Time
Retired
N/A

High School*

Check last grade completed.

College*

Check last grade completed.

College Major

Have you previously served as a volunteer?*

Yes
No

If yes, where?*

What type of service?*

Skills & Availability

Please select interests/preferences*

Please select all that apply.

Please select the days you are most often available to volunteer.*

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Please select the times you are most often available to volunteer on Sundays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Mondays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Tuesdays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer Wednesdays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Thursdays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Fridays.*

Please select all that apply.

Morning
Afternoon
Evening

Please select the times you are most often available to volunteer on Saturdays.*

Please select all that apply.

Morning
Afternoon
Evening

Skills/Experience

Clerical Skills

Typing
Filing
Computer skills
Medical Records
Mailings
Data Entry
Using Copier

Commuication Skills

Public Speaking
Journalsim
Photography
Graphic Art
Calligraphy
Public Relations

Please list any foreign language(s) that you speak.

Please list any skills/hobbies that you use or teach.

(such as baking, sports, hair styling/cutting, crafts, musical instruments, etc.)

Military Experience.

Please specify.

Reason for volunteering with Delaware Hospice.*

Personal Reference*

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Relationship*

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