Senior Support - Volunteer Intake Form
Thank you for your interest in volunteering! Senior Support Volunteers are contacting thousands of seniors in our database and are making sure that their food and medical needs are addressed.

Volunteer Job Description:
- During each phone call volunteers will complete a form that will act as a script to ask seniors important questions and check-in with them
- Volunteers will call their assigned seniors each week to check-in and ensure their needs are still being met
- Right now, we are NOT asking volunteers to deliver any groceries / medicine only to collect the information and allow us to take the next steps

If you have any questions please contact Molly Okun at
Sign in to Google to save your progress. Learn more
What is your full name? *
What is your email address? *
What is your phone number? *
How many seniors would you like to make phone calls to? Please note that this will also include following up with those seniors over the next 6-8 weeks. You can always request more seniors if you are able to. The phone calls will take about 5-10 minutes per call and not everyone will answer the phone.
Clear selection
Do you speak any other languages? Specifically Spanish, Russian, or Hebrew?
In the future we may be looking for volunteers who are willing to delivery groceries or medicine. Is this something you would be willing to do?
Clear selection
If yes to the above question - what zip code / neighborhood do you live in?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy