SunServe Phone Tree - Volunteer Form Survey

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1. Please provide the following (All information is confidential):

Please provide the following (All information is confidential): Name:
Address:
Address 2:
City/Town:
State:
ZIP:
Email Address:
Phone Number:

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2. Please indicate your gender:

Please indicate your gender: Male

Female

Transgender F to M

Transgender M to F

Other (please specify)

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3. How do you identify?

How do you identify? Gay

Lesbian

Bisexual

Straight

Other (please specify)

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4. Please indicate your status:

Please indicate your status: Single

Partnered

Married

Other (please specify)

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5. Please provide the following:

Please provide the following: Age:

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6. Please list an emergency contact:

Please list an emergency contact: Name:
Phone Number:

7. Please list any other language(s) you speak:

Please list any other language(s) you speak:

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8. Educational background:

Educational background: None

High school

Some College

College

Major/Degree

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9. Please provide the following information:

Please provide the following information: Occupation:
Hobbies:

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10. Do you like to talk on the telephone?

Do you like to talk on the telephone? Yes

No

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11. Can you commit to making a contact with a client on a daily basis?

Can you commit to making a contact with a client on a daily basis? Yes

No

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12. What is your preferred method of communication? (Please rank 1 thru 4; 1 is best)

Face to Face

Telephone

Email

Text

_4524797507_

_4524797508_

_4524797509_

_4524797510_

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13. Check all of the following which you have/use:

Check all of the following which you have/use: Land Line

Cell Phone

Computer / Internet

Email

Text Messages

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14. Indicate your electronic comfort zone by checking all statements which are true:

Indicate your electronic comfort zone by checking all statements which are true: I search/use the internet regularly and feel comfortable filling out forms on-line.

I love email.

The computer is not my friend, but I know how to use it.

My computer gathers dust.

I use text messages, but never when I drive.

I do not text at all.

I am comfortable with all forms of electronic communication.

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15. Have you attended a Phone Tree training session?

Have you attended a Phone Tree training session? Yes

No

Enter date if Yes:

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16. When are you available to volunteer?

When are you available to volunteer?

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17. Have you signed the SunServe Volunteer Agreement form?

Have you signed the SunServe Volunteer Agreement form? Yes

No

18. Travel plans: Will you be able to contact your client when away from South Florida?

Travel plans: Will you be able to contact your client when away from South Florida? Yes

No

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