Volunteer Application

Education Level

High School or GED
2 Year College
4 Year College
Masters Degree
Doctorate Degree

Community Where You Prefer to Volunteer

Do you need to fulfill any required community service?*

Yes
No

If yes, what type?

Are you a student?*

Yes
No

If yes, please provide your Day of Birth and School Attending:

What hours are you available?

Weekday mornings (8:00-12:00)
Weekday afternoons (12:00-4:30)

Is anyone else at home address a Benevilla volunteer?*

Yes
No

What type of volunteer activities interest you?

Please list your hobbies and any special skills you have:

Do you speak any foreign languages or know sign language?

Please indicate how you heard about Benevilla:*

Have you ever been convicted of a crime (other than traffic violations)?*

Yes
No

Describe your driving record for the past 5 years. Provide detail where needed. (This information is required for anyone who volunteers off campus.)

I understand that I will be required to provide three (3) personal or professional references and that I am able to obtain a Level 1 Arizona fingerprint clearance card. I am aware that background checks will be completed and a 39-month certified driving history record will also need to be supplied. I agree that I am fully vaccinated against COVID-19 or have a medical/religious exemption that I can provide. I am aware that I must attend an orientation before I am able to volunteer with Benevilla and further understand that additional training and documentation may be requested or necessary dependent upon my service placement.*

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Provide a safe and active place for older adults living with chronic illness.

Volunteer Application

Step 1 of 2

Contact Information

Emergency Contact Information