Age of Excellence

 

In the News:

AARP Applauds Senate Passage of Historic Health Reform Package
 Will help Medicare patients by closing the "doughnut hole" and strengthening laws against fraud, waste, and abuse.

Health Care Reform

 

Volunteer Application

Download a copy of the Application

Street
County
Email
Emergency Contact (name, phone, relationship)


Areas of Interest

Self-Management Program Leader
EnhanceFitness Leader
Matter of Balance Program Leader SMP Program Volunteer

Time Availability





If no, explain how you will have reliable transportation:
(you will not be expected to transport client, but will need t be at necessary appointments.)

Have you ever been convicted of a

References

Please list three (3) references other than relatives or previous employers:
Name
Street Address
City/State
Zip
Phone Number
Relationship
Years Acquainted
Name
Street Address
City/State
Zip
Phone Number
Relationship
Years Acquainted
Name
Street Address
City/State
Zip
Phone Number
Relationship
Years Acquainted

I acknowledge and agree that all information provided herein is accurate and true and hereby authorize REAL Services, Inc. to verify such information, contact references and conduct a criminal background check. I understand that I will not be paid for my services, as this is strictly volunteer work. I have read and understand the above statements.


 

 

 


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