[ Home ]
Request to Volunteer Form
This form is used by members who would like to volunteer. Please complete the information below. All fields MUST be complete; double check and make sure. Thanks for your help!
First Name: Last Name:
Email Address: Message Board Display Name: (if you know it)
Age: Type of Volunteer: Please select one! Stroke Survivor Stroke Caregiver Family Member Health Professional Other Date of Stroke? (if applicable)
Do you work? Please select one! Medically Retired Retired Caregiver Full-time Part-time No How much time can you commit to volunteer? Please select one! 1 Hr per Day Up to 4 Hrs per Day Up to 8 Hrs per Day 1 Hr per Week 10 Hrs or more per Week 10 - 20 Hrs per Week
How long have you been a member? Please select one! less than 1 year between 1 and 2 years between 2 and 3 years between 3 and 4 years between 4 and 5 years over 5 years Are you fluent in another language? Please select one! Spanish French German Italian Arabic Chinese Japanese Korean Indian Other No
Were you invited to volunteer? Please select one! Yes No Who invited you to volunteer?
Do you use the message board for support? Please select one! Yes No
Note: There is a minimum requirement of 100 meaningful posts for all Stroke Support positions. Any short and quick posts will not be counted. The purpose of this requirement is to evaluate your capability to provide effective support. Business Operations positions do not have a minimum post requirement.
Number of message board posts? (if applicable)
Please Specify Desired Job Position:
What is your background experience?
Please submit either a resume, CV or a short bio about your post-stroke situation, including ability to work:
Input text from image below:
Close Window