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Volunteer

Volunteer Application Hospice

Apply to Be a Hospice Volunteer Here

First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
What volunteer roles are you interested in?
Direct Services include: Patient and Family Visitation or Assistance, Patient and Family Respite, Child/Teen Care, Other
Indirect Services include: Administration, Fundraising, Community Education/Marketing, Child/Teen Programs, Other
E-Newsletters
We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however we will not send you any email you prefer not to receive. We will add you to our Volunteer E-Newsletter unless you choose to opt-out below.

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Please select your highest level of education completed.
Please list your previous volunteer experience.

Emergency Contact

In the event of an emergency, whom should we notify?

First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
Please provide a Reference
First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
Please provide Employer Name, Address and Phone Number
Please explain any significant losses you have experienced, their relationship to you, how long ago the loss occurred, and how it has affected you. Please also share your thoughts about life, death and dying.
Have you ever been charged or convicted of a crime, including child neglect or abuse? If yes, please explain.
I agree
As a trained Hospice Volunteer, I am willing to make a one-year commitment with Northwest Colorado Health.
I certify that all information provided in this application is true and complete. I understand that any false information or omission may disqualify me from further consideration from volunteering and may result in my dismissal if discovered at a later date.

1 in 3 people in the Yampa Valley utilize our services.

We serve all people, regardless of ability to pay.

Our impact this year has changed our community!

  • Patients at our Community Health Centers

    6,038

  • Volunteer Hours

    1,889

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