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Tellegacy:  Volunteers Serving Older Adults: Legacy Builders Sign-Up Form
University Student meets weekly via phone/virtual meeting for friendly conversation, and listening to older adults sharing their stories, their goals, and their legacy.
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First and Last Name *
Are you a Lay Volunteer or University Student Volunteer? 
If University Volunteer: Enter name of University or N/A *
Major / Interest or Field of Study
Expected Graduation Year
Phone Number *
Email *
Age
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Professor or Contact Who Introduced You to the Program.  How did you hear about the program?
(if applicable) Email of Professor or Contact who referred you to the Program.
Semester of your involvement
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Please indicate which is your position of interest for this program
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How many hours do you desire to complete by the end of the semester?  (If not applicable, please indicate "N/A"
Best Day/Time to Contact *
How many older adult residents would you like to call per week? (Sessions are one hour, once a week)
Have you ever been convicted of a felony or have been asked to resign from a volunteer position?  Please explain.  
Anything Else You Would Like Us To Know About You (Contact: Dr. Jeremy Holloway at jeremy.holloway@tellegacy.com, or 419-270-7511 for any additional questions.)
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