Meals on Wheels Volunteer Form

Name*

Email*

Address*

Phone

Work Phone

How did you hear about TCOA volunteer opportunities?*

How would you like to receive reminders about your upcoming volunteer shifts? Check all that apply. (Meals on Wheels only)

Text

Phone Call

No Reminder

You may change your preference at any time by contacting your Meals on Wheels volunteer coordinator.

Volunteer Experience (Agency/Organization Name and Volunteer Role)

Personal References (Name, Email, and Telephone number for Two or More Individuals Other Than a Relative)*

Employment Background (Present and Past Employers and Positions Held)

Volunteer Positions*

Please review the Job Description(s) for the volunteer position(s) you are interested in.

Nutrition Program (Meals on Wheels): Drive your own car or go with a partner and deliver lunches to participants who are unable to prepare their own meals. Most volunteers drive one lunch hour a month, others prefer to deliver more often. Mileage reimbursement is available. Routes take about 1 hour.

Nutrition Program (Dining Sites): Help dish up food at dining sites across the tri-county area. Also needed are individuals to help with educational and entertainment programs for the sites.

Nutrition Program (Central Kitchen): Help prepare food or package individual meals.

State Health Insurance Assistance Program (SHIP) Counselor Meet with clients and take hotline callers who have questions and concerns about Medicare, medical bills, long-term care insurance, Medigap and Medicaid.

Workshop Facilitators/Trainers: Facilitate evidence-based workshops or programs by leading groups and sharing health and wellness information. Specific topics may include caregiver support, caring for someone with dementia, the fear of falling, chronic pain, and diabetes management. Training is provided.

Special Events: Plan and/or participate in the annual Meals on Wheels Golf Outing and/or TCOA Dinner and Auction. Solicit sponsors, secure prizes and items for live and silent auctions, assist with raffle sales, and/or volunteer on event day.

General Administrative Volunteer: Participate in general office duties such as data entry, stuffing envelopes, and/or placing phone calls to gather and update resource information.

Propose your own Volunteer Role:

Propose Your Own Custom Volunteer Role*

Acknowledgements and Signature

Consent for Reference Check*

I give permission to Tri-County Office on Aging to contact my references using the contact information I provide on this form.

Confidentiality Agreement*

I understand that as a volunteer for Tri-County Office on Aging, I could have access to privileged information about the clients/volunteer stations I am serving, including medical, insurance, and other confidential/personal data. I agree to restrict my use of such information to the performance of my duties. I will not discuss any case or mention any client’s/station’s name, or otherwise reveal or disclose information pertaining to any client, except when in direct contact with other federal, state or local agencies, and then only for the purpose of assisting the client/station. I hereby acknowledge my obligation to respect the privacy and the confidentiality of the information pertaining to clients/volunteer stations and to exercise good faith and integrity in all dealings with the volunteer station(s) I serve, their clients and their personal information. I also understand that any unauthorized use or disclosure of information pertaining to a client or a volunteer station may result in my immediate suspension and/or dismissal and may subject me to civil liability for breaching the client’s/station’s right to privacy.

Job Descriptions and Handbook*

Please review the Job Descriptions for each Volunteer Position that interests you in the Job Descriptions section above. You may download and save the Job Descriptions and Handbook from your browser. The Job Descriptions and Handbook are intended to give an overview of the role and TCOA. Volunteers will receive training and have an opportunity to ask questions when assigned to a program, or may contact TCOA with questions at any time. To request a printed copy or to request materials in another language, please contact 517-887-1487 or email [email protected].

I have read and understand the Job Description(s) for the volunteer role(s) I am applying for.

I have read and agree to follow the TCOA Volunteer Handbook

Signature*

By typing your name above, you agree that your electronic signature is the legal equivalent of your physical signature.

Date*

Signature

Background Check Consent Form

I give my permission for the following information to be used by Tri-County Office on Aging to secure information regarding my "conviction only" criminal history. I understand that the information provided below will be kept confidential and used for the sole purpose of checking my criminal history records every three years. Any information obtained by Tri-County Office on Aging will also be kept strictly confidential.

Name*

Date of Birth*

Sex*

Male

Female

Race*

Ethnicity*

Hispanic or Latino

NOT Hispanic or Latino

Have you lived outside the state of Michigan in the last 7 years?*

Yes

If yes, we will contact you for additional information.

Alias names used, including previous married names or maiden name:

Signature

Date

By typing your name above, you agree that your electronic signature is the legal equivalent of your physical signature.

Thank You

TCOA staff attempt to reply to volunteer inquiries within 1-3 business days. If you have not heard back from TCOA within a week, please check your spam/junk folder, then call 517-887-1487. If you would prefer to mail in your application and background check consent form, please see the downloadable link below.

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Volunteer Qualifications

Volunteer Job Description

Acknowledgements and Signature

Background Check Consent Form

Thank You

Quick Links

Please contact us if you are looking for a job.

Quick Links

Contact info

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Meals on Wheels Volunteer Form

Volunteer Qualifications

Volunteer Job Description

Acknowledgements and Signature

Background Check Consent Form

Thank You

Quick Links

Please contact us if you are looking for a job.

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