Empowering communities through your support and compassion. Volunteer Application Please share your first and last name * First Name Last Name Please enter your current address * Address 1 Address 2 City State/Province Zip/Postal Code Country Please enter your primary phone number * (###) ### #### Email * Please indicate your interest from the available categories below: * Governance Advisory Committee (advocacy for systems/continuous improvement) PSL Event Support Assist with Support Groups Family outreach In Office Support (e.g., copying, assembling communication packets) Note: You will receive a $50 stipend for each two hours you volunteer. Please indicate days available: * Monday Tuesday Wednesday Thursday Friday Available start time * Hour Minute Second AM PM Available end time * Hour Minute Second AM PM Any physical limitations? * Emergency Contact Name * First Name Last Name Emergency Contact Phone Number * (###) ### #### As a volunteer with PSL, I agree give permission for a background/Caregiver check, PSL policies and procedures including your commitment to protect the confidentiality of family information. You will be required to sign a confidentiality agreement upon acceptance as a PSL Volunteer. * Yes No Thank you!
