Elder Law of Michigan : Volunteer Your Time : Application Form

Volunteer Application Form

Printable Application Form

| Background Check Consent Form

General Information:

Name

County

Phone number

Alternate Number

Email Address

Current Address

Permanent Address

(if different from Current Address)

In an emergency, please contact:

Name

Phone number

Relationship

Program Interest:

Which programs are you interested in volunteering for?

(Check all that apply)

Availability:

Times

Days

Hours Per/Week

Confidentiality Agreement:

I understand that my volunteer association with Elder Law of Michigan may at times expose me to confidential written and spoken information. I understand that I am not to discuss any information about Elder Law of Michigan cases or clients with anyone other than Elder Law of Michigan staff or volunteers.

I also understand any documents containing social security numbers or other personal information must remain secured at all times. Anyone caught improperly using a client’s social security number or other client information will be immediately discharged and if necessary, criminal prosecution will be pursued.

By checking here, I acknowledge that the information provided in this application (and attached resume, if applicable) is complete and true to the best of my knowledge and may be verified by Elder Law of Michigan.

*REQUIRED*

Upload Resume:

Resume

Writing Sample (if applicable)

Form will be sent directly to Elder Law of Michigan, Inc. *To keep our clients safe, volunteers must pass a criminal background check.