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Patient Care Volunteer Application

Applicants must be 18 years or older and have a valid U.S. Social Security Number and Driver’s License/ State ID. We ask for a 1-year minimum commitment and 4-hour per week availability for our general patient care volunteers. (6 month, 2-hour per month minimum commitment for volunteers providing licensed/ certified specialty services only)

* Required Fields

General Info
Do you own an automobile / motorcycle?
Emergency Contact Info
About You


Have you ever been convicted of a felony or been notified of any exclusion actions?*

Specialty Skills

Other Skills:
License Type:
License #:
Expiration Date:
References

I understand that I will be required to provide two reference forms to individuals who know me on a personal or professional basis. By checking this box, I am authorizing San Diego Hospice and The Institute for Palliative Medicine to contact my references regarding my appropriateness as a patient care volunteer. ← Check Here

Referral Source

How did you hear about volunteering with San Diego Hospice and The Institute for Palliative Medicine?

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Name:
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619-688-1600 local 24 hours | 866-688-1600 toll-free 24 hours within the United States | E-mail Us

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San Diego Hospice and The Institute for Palliative Medicine is a 501(c)(3) non-profit organization that relies on charitable support to provide its programs and services.


 
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