Demo Village. A community of seniors supporting each other as they age in their own homes

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Your Information

First name

Last name

email

Phone

Cell phone

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Date of birth

Marital status

Gender

Sexual orientation

Local village

Race

Ethnicity

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Address

Number

Street

City

State

Zip Code

Areas of Interest for Volunteers

Assistance PC Consulting Drive Errands Friendly Visit Gardening Grocery/Meal deliver Handy Person In Home Assistance Management/Coordination Organizing Read aloud Snow removal

Volunteer for Demo Village

Accounts payable Administration Answering Phones Cleaning Data Entry Envelope Stuffing Event Helpers IT Technical Phone Outreach Provider Vetting Service Requests Special Gift Bag Supporting Seniors Website maintenance

Additional Information

First Reference

First reference name

First reference relationship

First reference email

First reference cell phone

First reference phone

Second Reference

Second reference name

Second reference relationship

Second reference email

Second reference cell phone

Second reference phone

Previous Volunteer Experience?

Do you have a current and valid drivers license? Do you have current and valid car insurance?

Current Health

Mobility issues

Home type

Employment status

How did you hear about us

Do you hold an OLLI Membership?

Additional Comments

I confirm that I have read, consent and agree to Revolutionaging’s (Helpful Village’s) TERMS OF USE and PRIVACY POLICY

Volunteer Application Form