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Ethos Volunteer Application

BASIC INFORMATION

First Name

Last Name

Home Phone

Mobile Phone

Address

City

State

Postal Code

State- Other

Email

Preferred method of contact

How did you hear about Ethos?

Languages Spoken

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:

MaleFemaleTransgender

Do you identify as LGBT?

YesNo

EMPLOYMENT AND VOLUNTEER EXPERIENCE

Employer Information

Are you retired? YesNo	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.

CarMBTAOther

When are you available to volunteer? Check all that apply.

WeekdaysWeekendsEvenings

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 INTERESTS

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 providedSHINE (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 habitsTai 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

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Contact Us

Ethos

555 Amory Street

Jamaica Plain, MA 02130

Tel: 617.522.6700
Fax: 617.524.2899

Email Us

Our Mission

Ethos is a private, not-for-profit organization that promotes the independence, dignity, and well-being of the elderly and disabled. Ethos achieves its mission through the coordination and delivery of high-quality, affordable home and community-based care. In all aspects of its work Ethos supports family caregiving, fosters social interaction and respects cultural diversity.

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Home Care
Nutrition
Counseling & Supportive Services
Healthy Aging Classes

Contact Us

Ethos
555 Amory Street
Jamaica Plain, MA 02130
Tel: 617.522.6700
Fax: 617.524.2899

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About
Services
Aging in Community
News & Events
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- Volunteer Application
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