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Greater Illinois Chapter
 Volunteer Interest Form

Thank you for your interest in volunteering with the Alzheimer’s Association. The work of volunteers is critical to achieving our vision of a world without Alzheimer’s disease.

Please complete this form to help us best meet your volunteering interests.

Bold indicates a required field.

Address/Contact Information
First Name
Last Name
MI
Home Address
City
State
Zip
County
Date of Birth
(dd/mm/yyyy format)
Home Phone
Cell Phone
Email
Employer
Job Title
Does your employer allow paid days off for volunteer activities? Yes
What is the best way to contact you?

Volunteer Information
How often would you like to volunteer?
Daily
Weekly
Monthly
Occasionally
Other
Which office location are you interested in?
What days of the week are you available?
(Check all that apply)
Mon Tues Wed Thur Fri Sat Sun
Mornings
Afternoons
Evenings
Please check the areas you are interested in:
General Office Work Special Event Team Participant
Data Entry/Typing Phone Calls
Library Health Fair Representative
Helpline Advocacy
Special Event Committee Speaker
Special Event/Day of Event Support Group Facilitator
When would you like to begin volunteering?

Please list any specific areas of volunteering you are interested in.
What interests or experiences do you have that may benefit the Alzheimer’s Association?
Please describe any previous volunteer activities.

The Alzheimer’s Association does not discriminate based upon age, gender, sexual orientation, race, religion or physical disability.
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Chapter Headquarters
Greater Illinois - 8430 W. Bryn Mawr, Suite 800,
Chicago, IL 60631 Phone 847.933.2413

Alzheimer's Association National Office 225 N. Michigan Ave., Fl. 17, Chicago, IL 60601
© 2007 Alzheimer's Association. All rights reserved.

24/7 Helpline: 1.800.272.3900