Maitri Volunteer Application

Personal and Contact Information
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Zip Code
Mobile or Home Phone *

Area Code Phone Number
Your Birthdate *

Month Day Year
Date
Your Occupation *
How did you hear about Maitri? *

General / word of mouth Conversation with family, friends or colleagues Professional recommendation Through a former resident or staff member Article, book or other publication Printed flier Online search
What times are you available? *

Your Physical and Emotional Health
Have you ever had a communicable disease that could now be a potential risk to a person with AIDS? *

Yes No
If "Yes," please describe:
Do you have any condition(s) that puts you at risk for contracting a communicable disease? *

Yes No
If "Yes," please describe:
In the last six months, have you experienced a major life change? (e.g., death or other loss, change in job, living situation or relationship, etc.) *

Yes No
If "Yes," please describe:

Help Us Know You Better
Why do you want to volunteer at Maitri? *
Describe your personal experiences with death, grief, and any feelings you may have about the grieving process. *
Anything else you would like us to know?

We appreciate the time and thought involved in completing this application. Thank you for your interest and support. If you have questions, please feel free to call us at 415-558-3000.
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