Volun-Peer Mentor Form

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    Personal information
    • Okay to call at work

    • WeeklyEvery Other WeekMonthlyAs Needed

    • MorningAfternoonEveningDuring the WeekWeekends

    • Do you routinely leave the area for an extended time at a particular time each year?

    • AllNorthsideSouthsideOnalaskaHolmenWest SalemBangor

    • YesNo

    • CigarettesPipeOther

    • You must abstain while volunteering.

    • DogsCatsBirds

    • No Pets

    Volun-Peer Matching
    • Please provide any information about yourself that will help in finding a lasting match.

    • Please list any previous mentoring experience:

    • Please list any previous caregiving experience:

    • Share any additional information here:

    Volun-Peer Mentor Services
    • Provide support and encouragement to caregiver(s) of a recipient

    • Please check all that are of interest (Time given denotes acceptable length of service)

    • Phone, Email, Visiting Call, email or visit at least once a week to encourage and support (2-4 hrs/month)

    • Socialization Spend time with caregiver and recipient for socialization in the community (2-4 hrs/month)

    • Attend Lunch Bunch or Support Groups Provide transportation for caregiver and recipient (2-4 hrs/month)

    • Office Volunteer Assist in the office with mailings or newsletter, compiling mentor hours, etc. (2 hrs/month)

    • (Time varies)

      As a volunteer within The Aging and Disability Resource Center of La Crosse County for the Peer Caregiver Support Program. you share your time and talents by being matched with a person who has requested a Volun-Peer Mentor. In order to ensure volunteer safety and the quality of our program work, we ask you to please read and respond to the following questions. Causeway Caregivers performs a background check under the direction of The Aging and Disability Resource Center of La Crosse County on all mentors, caregivers and care recipients to determine eligibility.
    • YesNo

    • YesNo

    • YesNo

    • YesNo

    • YesNo

    • YesNo

    • Note: Failure to volunteer within guidelines may make you ineligible to volunteer.

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