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 be in touch with you.  You may always check our website at www.oregon.gov/ltco for current updates.  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:

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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!  We will send you email updates as trainings are added in your area.  You are welcome to attend an online open house.  Dates and times vary so visit the volunteering portion of our website to register.
Please feel free to make any other comments or ask specific questions below.

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