Volunteer Application

Your Name


Local Address

Street:

City:

State: Zip:


Permanent Address (If different from local):

Street:

City:

State: Zip:


Local Phone:

Cell Phone:

Email

Days & times available:

If student, which semesters?

Do you have a car?
YesNo

Are you able to commit to 1 year (2 semesters if student) of volunteering?
YesNo

Why do you want to volunteer with us?

What experiences have you had with cancer and/or those affected by it?

Please tell us a little about yourself. What is your profession? Do you have any special skills or certifications? Are you fluent in any foreign languages?

List your previous and/or current volunteer experience:
Organization / Responsibilities / Dates

Person to contact in case of emergency:
Name / Address / Phone (home & cell)

Please list three people whom we may contact as references. Include at least one current or former supervisor from a paid or volunteer position. Do not include family members or (if possible) friends.
Name / E-mail / Phone / Relationship

I, , give my consent for the release of information about me from the references above.

Signed
Date


 

 

**Please indicate your interest in the following opportunities by checking "yes" or "no"**

I. Direct Client Services

Ride Provider:

Volunteers are needed to give occasional rides to medical appointments for clients who don’t have reliable transportation or are too weak to drive. They may also be requested to accompany the client into their doctor’s office to provide support during the appointment.

Friendly Correspondent:

This option is ideal for people who are looking to volunteer in a meaningful way, but are limited with their time. They send a monthly greeting card to clients who are isolated and/or need some extra support.

 

Client support training is provided for the following positions:

Cancer Resource Center Office:

Volunteers staff our reception area during regular business hours. They answer phones, greet visitors, meet with clients, assist in the Boutique, and do projects as needed. Please check ALL shifts you are available for:

MONDAY am pm
TUESDAY am pm
WEDNESDAY am pm
THURSDAY am pm
FRIDAY am pm

Cancer Support at Cayuga Medical Center:

Volunteers are a regular presence in the waiting room of Radiation Medicine and the chemotherapy suite. They greet patients as they arrive for appointments, talk with family members, serve coffee and food, and sometimes accompany a patient during a consultation with the doctor. Please check ALL shifts you are available for:

MONDAY am pm
TUESDAY am pm
WEDNESDAY am pm
THURSDAY am pm
FRIDAY am pm

Financial Advocate:

Volunteers assist individuals and their family members with financial issues related to their cancer diagnosis. They may help with any of the following: organizing bills, identifying resources to help pay for medical bills and expenses, filling out forms, appealing insurance company denials, etc.

 

II. Non-Direct Services

Walkathon:

Our biggest fundraiser of the year requires over one hundred volunteers and months of planning. Take part in the action by helping with flyer distributions, contacting local businesses, identifying team leaders to raise money, and much, much more.

Board of Directors:

The board of directors is responsible for policy development and oversight of the entire organization. Board members play a key role in CRC relations with the greater community.

Committees:

Development, Finance, Client Services, and other committees are comprised of community members, board representatives, and staff. Individuals with a genuine interest in the mission of CRC, who communicate well with others, and who bring a wide range of interests and backgrounds are sought to complement the roles of board and staff.

Interns:

Students from Ithaca College, Cornell, and TC3 help CRC with long-term projects such as publicity, marketing, program evaluation, research, grant writing, etc. They work in conjunction with staff to fulfill course requirements.

 

Confidentiality Agreement

In your work with CRC you may become aware of the names of our clients and personal information about their lives and medical situations. You may also be entrusted with information about staff and donors. We require that this information remain confidential.

Information contained in CRC’s internal documents is considered confidential as well. Unless you are specifically authorized to provide this information, the material should not be shared.

By signing below, you agree to maintain the confidentiality of CRC clients, staff, donors, and the organization itself.

Signature:

Today's Date: