Application Form

 

All of your information is kept confidential and will not be available to any individuals or organizations other than the Adventures in Caring Foundation.


Your Name (required)

Your Email (required)

Date of Birth

Street Address

City, State, Zip

Your Cell #

Driver's License #

Employer (School, Year & Major if full-time student)

Parent's name & permanent adress (if full-time student)

Permanent phone #

Previous experience and education in the health/helping professions, and/or volunteer work

Have you experienced a severe illness and been hospitalized yourself? (If so, how long, how often?)

How did you find our about the Raggedy/Ann & Andy program?

Why are you interested in this program?

How do you feel about your ability to listen and communicate, especially during the emotionally difficult situations which frequently arise during illness, injury, aging and dying?

If you have ever participated in programs or practices which emphasize personal or spiritual development, please mention those you found most meaningful:

List three references who know you well (not your family or Adventures in Caring staff.) These people should be aware of your communication skills, and either your work in the health/helping professions or your volunteer work.

Name 1:

Phone #:

Email:

Name 2:

Phone #:

Email:

Name 3:

Phone #:

Email:

Parents or Next-of-kin (in case of emergency):

Phone #:

Next of kin Email:

I understand that not everyone is well-suited to volunteering as an Adventures in Caring intern, and that attending the training seminar does not guarantee my being accepted into the internship program. This decision is made by the Adventures in Caring training staff. If I am not accepted into the program, I will receive a full refund of the training fee.

 I agree


Note: If you don’t hear back from us within 48 hours of sending in your application, please e-mail: Shelley@AdventuresInCaring.org and ask if your application was received.