Application Form

Application Form

Personal Information


Other Information

Work or volunteer experience

Have you had fundraising/special event experience?(Required)

Committing time to Prairie Hospice Society

Are you willing and able to commit to volunteering for one year or more?(Required)
Are you willing and able to commit to volunteering approx. 4 hours per week?(Required)
Are you able to attend the mandatory training program? (approx. 20 hours)(Required)
Do you have any long vacations/absences planned?(Required)
Are you typically away for extended periods at a time?(Required)


General Availability: Please describe your availability to volunteer below.

Volunteer Preferences

(check those that apply)
Client Service Volunteer Work:
Other Volunteer Work you would have an interest in at Prairie Hospice Society:


Do you have a valid Driver’s License?(Required)
Would you be willing to provide transportation for clients?(Required)


Do you have pets?(Required)
(Some of our clients are allergic to animals.)
Do you have any concerns about volunteering? Please check them off below:(Required)
Do you have any apprehensions about working with individuals who have a different background than yours?(Required)


Do you have a preference about the age or sex of the client you will be matched with?(Required)
Prefer working with:(Required)


Check off any skills or hobbies, activities or interests you will be able to share in the volunteer role. This will help us in matching you to an appropriate client.

Emergency Contact Information


Personal References: (Friend, Volunteer or Work related) These individuals must be over 20 years of age, should have known you for more than 2 years and may not be a partner, spouse, family member or your therapist/counselor.

Reference #2