Submit Application Online

Please complete the application as fully as possible to help us help you, thank you!
  • Contact Information
  • Emergency Contact:
  • Personal Information
  • Please use numbers 1 – 5 (1 being most important) to indicate the relative importance to you of the following goals in doing hospice volunteer work:
  • to be part of a team
  • to meet new people
  • to be of service
  • to be involved in your community
  • to gain increased self knowledge
  • References: (Please list persons from school, church, synagogue, employment, or past volunteering. Do not use family members or close friends.)
  • I understand that the information provided in this application to volunteer with Weinstein Hospice is part of the volunteer permanent file. This information will be kept confidential and only be used to assist Weinstein Hospice in completing its volunteer screening process and in making the best possible match between me and a patient and/or assignment with the hospice.

    I also understand that if I am accepted as a volunteer, I am committed to attending volunteer education and training sessions provided by the hospice and to abiding by the Policies and Standards of Practice of Weinstein Hospice.

    I hereby certify that all information included in this application form is true and complete. I give permission to an authorized hospice representative to conduct reference checks with the above named referees and to submit my name for a criminal history background check with the state of Georgia.

  • Type your name to verify you understand conditions above
  • Date