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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