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Ethos Volunteer Application
BASIC INFORMATION
First Name
Last Name
Home Phone
Mobile Phone
Address
City
State
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Email
Preferred method of contact
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Home Phone
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How did you hear about Ethos?
Languages Spoken
Please select...
Spanish
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Italian
Greek
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Haitian Creole
Cape Verdian Creole
Mandarin/Chinese
Cantonese/Chinese
Japanese
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Other
Hindi
Other Language Spoken:
DEMOGRAPHIC INFORMATION
Please note that this information is used strictly for reporting purposes and is kept confidential within the Volunteer Services Department.
Date of Birth (mm/dd/yyyy)
mm/dd/yyyy
Ethnicity
White/Caucasian
Black/African American
Other
Hispanic/Latino/Latina
Asian
American Indian
Other Ethnicity
Highest Degree of Education Obtained:
Currently in High School
High School Diploma or Equivalent
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate
Other
Some Elementary, Middle, or High School
Other Education:
Gender:
Male
Female
Transgender
Do you identify as LGBT?
Yes
No
EMPLOYMENT AND VOLUNTEER EXPERIENCE
Employer Information
Are you retired?
Yes
No
Employer (or previous employer if retired or unemployed):
Position Title:
Employer's Address:
Volunteer Experience
Organization:
Organization:
Volunteer Position:
Volunteer Position:
AVAILABILITY AND LOGISTICS
How would you travel to your volunteer assignment? Check all that apply.
Car
MBTA
Other
When are you available to volunteer? Check all that apply.
Weekdays
Weekends
Evenings
List any exceptions to your availability:
ADDITIONAL CONTACTS
Emergency Contact
Emergency Contact Name
Relationship
Phone
Email
Please list three references (not related to you)
One reference should be a professional contact, such as a teacher, minister, or employer.
Reference #1
Reference Name
Relationship
Phone
Email
Reference #2
Reference Name
Relationship
Phone
Email
Reference #3
Reference Name
Relationship
Phone
Email
VOLUNTEERING INTEREST
S
Please check all of the volunteer positions that you are interested in:
Friendly Visitor
- Meet with an elder in his/her home to relieve loneliness, provide companionship, and share interests. Hours: 1–2 hours per week; 6 month commitment.
Medical Escort-
Escort an elder to a medical appointment and back to his/her home. Hours: On-call basis with the right to decline; generally 2–3 hours per week; 3 month commitment.
Shopper/Shopping Escort
- Shop with or for a senior and assist in storing items at their home. Hours: 1–2 hours per week; 6 month commitment
.
Telephone Reassurance Caller-
Make telephone calls to elders on a weekly basis to help relieve loneliness and check on their well-being. Hours: Flexible hours; 3 month commitment.
Computer Coach-
Work one-on-one with seniors in their homes to help them learn to use the computer; topics of instructions include basics, email, Skype, Microsoft Word, and the internet! Hours: 1 hour per week for 6 weeks.
Long-Term Care Ombudsman-
Advocate for residents in long-term care facilities/residential care facilities, resolve complaints, monitor Federal & State laws regarding residents’ rights. Vehicle is essential. Hours: 2– 3 hours per week between 10:00 am and 8:00 pm; 1 year commitment. Training and supervision: A 3 full-day training provided by the state; 6 month probation period with supervision from staff.
Money Manager-
Assist an elderly or disabled person to manage their finances by developing a budget, helping with check writing, and balancing their checkbook. Hours: Once a month, flexible hours. Training and Supervision: A one-time individual training is provided
SHINE (Serving the Health Insurance Needs for Everyone) Counselor-
Improve the lives of people who are Medicare-eligible by providing information and assistance through direct in person and over the phone counseling at Ethos and community centers throughout Boston. Hours: 1-5 hours per week Training and Supervision: Extensive, weekly training for 6 weeks; must pass a certification exam.
Healthy Aging Course Leader-
Demonstrate your leadership skills and teach one of our evidence-based programs! Our Healthy Aging programs help elders prevent or delay chronic diseases, learn skills and gain confidence to manage their health and live healthier, active lives. Hours: Generally 2–3 hours per week; 6 month commitment. Training and supervision: Group training in each Health Aging course required; weekly supervision and support is provided to guarantee the workshops’ success.
Nutrition Program-
Ethos holds over 20 daily, weekly, and monthly community cafes where local seniors can drop in for a free nutritious meal and some socialization. Volunteers are needed to help set up, serve meals, socialize with seniors, and clean up after the meals. Hours: Varies by meal site and volunteer role
Office Assistant-
Work on special projects, update databases, copy and file papers, or answer phones at Ethos. Hours: 2–20 hours per week; 3 month commitment. Training and supervision: Varies per placement.
Intern-
Internship needs vary dependent upon season and current agency need. Potential internship focuses include marketing and communication, website development, community organizing and volunteer recruitment. Ethos also offers field placement opportunities for graduate-level Social Work, Mental Health Counseling, and Clinical Psychology students. Hours: Varies per internship. Training and supervision: Varies per internship
.
You're Interested in becoming a
Healthy Aging Course Leader
...do you have a particular interest in leading any of the following courses?
A Matter of Balance: reduce the fear of falling and increase activity levels
“My Life, My Health”: teach methods to deal with chronic diseases, pain, and fatigue
Healthy Eating: teach nutrition strategies for heart and bone health
Memory Fitness: help elders develop critical good memory habits
Tai Chi: help elders move for better balance and prevent falls
Seasonal/One Time Volunteer Opportunities:
Thanksgiving Meal Delivery
Deliver meals to home-bound elders at senior housing and/or individual homes on Thanksgiving Day. Hours: 2 – 3 hours the morning of Thanksgiving Day.
Event Support-
Assist as Ethos event such as social events for seniors and our annual fundraiser. Tasks include setting up, greeting guests, serving meals, and cleaning up. Hours: Several hours at a time, one time commitment
ANYTHING ELSE?
Share your individual skills and interests with Ethos clients (max 250 characters)!
Contact Information
Donate now
Follow Us
Contact Us
Ethos
555 Amory Street
Jamaica Plain, MA 02130
Tel:
617.522.6700
Fax:
617.524.2899
Email Us
About Us
History
Mission
Leadership Team
Board of Directors
Employment
Save Our Seniors
Request for Proposals
Testimonials
Services
In Home Services
Home Care
Personal Care Attendant
PCA Program Guide
Options Counseling
Boston Allied Partners
Nutrition
Meals on Wheels
Meals on Wheels Menus
Community Cafes
Healthy Aging Classes
A Matter of Balance
Tai Chi for Seniors
Tai Ji Quan: Moving for Better Balance
Chronic Disease Self-Management
Diabetes Self-Management
Healthy Eating
Healthy IDEAS
Make a Healthy Aging Referral
Counseling & Supportive Services
Long Term Care Ombudsman
Elder Mental Health Outreach Team
Healthy IDEAS
Money Management
SHINE
SHINE Locations
Resources
Boston ElderINFO
Care Coordinate
LGBT Programs
AgeWell Equality
LGBT Elders Resource Guide
Cafe Emmanuel
Ethos Equality Fund
Annual Senior Pride Luncheon
Aging in Community
AgeWell West Roxbury
Healthy Aging Classes
A Matter of Balance
Tai Chi for Seniors
Tai Ji Quan: Moving for Better Balance
Chronic Disease Self-Management Program
Diabetes Self-Management Program
Healthy Eating
Healthy IDEAS
Make a Healthy Aging Referral
JP@Home
About JP@Home
JP@Home Membership
JP@Home Business Membership
Current Business Members
Join JP@Home Now!
Renew Your Membership
Frequently Asked Questions
JP@Home Service Map
Submit a Service Request
JP@Home Newsletters
JP@Home Newsletter Submission
Options Counseling
News & Events
News
Events
Events Calendar
Healthy Aging Classes
Community Cafes
Press Releases
Media Coverage
Videos
Photos
Senior Portraits
Testimonials
Volunteer
Volunteer
Volunteer Application
Donate
Donate Now
Donor Advised Funds
Honor/In Memoriam
Plan Your Legacy
Corporate/Foundation
Gifts of Stocks and Securities
Contact
Contact Ethos
Make a Referral
Make a Healthy Aging Referral