New Long-Term Care Ombudsman Certified Ombudsman Volunteer Training contact list

Long Term Care Ombudsman Volunteer Interest Form

Thank you for your interest in serving the Long-Term Care Ombudsman program as a volunteer. Please complete the form below and we will contact you to provide more information. You may always check our website at www.oltco.gov to learn more about services and volunteering. Your contact information will not be shared or sold to anyone.

Note: This form is not intended for the reporting of a complaint or concern about a long-term care facility. If you have such a concern, please call our toll free number: 800-522-2602

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* 1. First Name

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* 2. Last Name

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* 3. City

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* 4. County

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* 5. Email Address

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* 6. I would like to receive additional information about:

Volunteering as a Certified Ombudsman for the Long-Term Care Ombudsman Program (serving residents in Assisted Living, Residential Care Facilities, Nursing Facilities, and Adult Foster Homes).

Volunteering in an administrative role (recruiting other volunteers, community presentations, pro bono professional support)

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* 7. Would you like us to email or mail you an application packet?

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* 8. Phone Number where we may reach you (optional)

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* 9. If you volunteer with our program, can you meet these requirements?

I can pass a criminal history check

I can commit to giving 4 hours a week for at least a year (not including vacations or short leaves of absence)

I'm over 21

I have NOT worked at a long-term care facility within the past year

I do not have any financial interest in long-term care facility where ombudsman services are provided

I can commit to completing 48 hours of training (combination in person, self study, and online)

I can begin volunteer services within 2 months of the completion of training.

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* 10. When attending training, I am able to:

Travel less than 10 miles to a training location

Travel between 10-50 miles to a training location

Travel more than 50 miles to a training location if travel expenses are reimbursed by the agency once I am actually certified as a volunteer.

I would prefer a training to be held as near as possible to my city: (enter city below)

I would prefer a training near this city

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* 11. Thank you! You are invited to participate in an online open house. Dates and times vary so visit the Long-Term Care Ombudsman volunteering portion of our website to register.
Please feel free to make any other comments or ask specific questions below.

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* 1. First Name

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* 2. Last Name

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* 3. City

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* 4. County

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* 5. Email Address

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* 6. I would like to receive additional information about:

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* 7. Would you like us to email or mail you an application packet?

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* 8. Phone Number where we may reach you (optional)

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* 9. If you volunteer with our program, can you meet these requirements?

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* 10. When attending training, I am able to:

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* 11. Thank you! You are invited to participate in an online open house. Dates and times vary so visit the Long-Term Care Ombudsman volunteering portion of our website to register.Please feel free to make any other comments or ask specific questions below.

* 11. Thank you! You are invited to participate in an online open house. Dates and times vary so visit the Long-Term Care Ombudsman volunteering portion of our website to register.
Please feel free to make any other comments or ask specific questions below.