Alzheimer's Association, NYC Chapter
60 East 42nd Street | Suite 2240 | New York, NY 10165 | 646.418.4466 | alz.org/nyc

Alzheimer's Association, NYC Chapter - Volunteer Survey

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support and research. The mission of the Alzheimer’s Association is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through brain health. Our vision is a world without Alzheimer’s. To learn more, visit alz.org/nyc or call 800.272.3900, anytime.

Thank you for your interest in volunteering with the Alzheimer's Association, NYC Chapter. We conduct preliminary screening of all volunteer applicants to identify areas of interest and expertise, and to match them with our current needs. This application is not a commitment or promise of volunteer opportunity or employment. Please take a moment to answer this brief survey. If your application meets our initial criteria, we will contact you to schedule an interview.

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. In what ZIP code is your home located? (enter 5-digit ZIP code)

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* 4. At what email address can we reach you?

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* 5. At what phone number can we reach you?

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* 6. How did you hear about us?

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* 7. Why are you interested in volunteering with the Alzheimer’s Association?

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* 8. What experiences have you had that may prepare you to work as a volunteer in the field of Alzheimer's disease?

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* 9. What type of activities are of interest to you? Check all that apply. (Note: Asterisk indicates training course required)

Public Education and Disease Awareness Program Assistance*: Help us reach the communities you care about by making presentations and providing information & referral services at neighborhood events, community centers, faith-based organizations, and in the chapter office.

Support Group Facilitators*: Professional and trained volunteers lead groups to support individuals with Alzheimer's, adult caregivers and others.

Walk to End Alzheimer's: Be a part of the world's largest event to raise funds for Alzheimer's care, support and research. We have a variety of roles available, including a year-round planning committee, team recruitment opportunities, and event-day support.

The Longest Day®: On the summer solstice, June 21, 2017, individuals and teams across the world will join the Alzheimer’s Association® to do an activity they love — or an activity loved by those affected — to raise funds for care, support, and research to help end Alzheimer’s. We have a variety of roles available, including a year-round planning committee, team recruitment opportunities, and event-day support.

Advocacy and Public Policy: Advocates are trained to work with local elected officials to create meaningful changes on the state and federal level to advance research, care and support services.

Office Support: Move our mission forward by supporting a variety of professional and administrative office activities, such as materials fulfillment, marketing strategy, design & communications efforts, and data management*.

Other (please specify)

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* 10. Would volunteering or being placed at the Association fulfill part of an academic or degree requirement?

Yes

If yes, please detail (degree sought, name of school, time required).

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* 11. Are you fluent in any of the following languages? (Check all that apply)

Spanish

Haitian-Creole

Chinese (Cantonese)

Chinese (Mandarin)

Korean

Russian

Bengali

Other (please specify)

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* 12. Please indicate the hours you would be able to volunteer

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Morning	Morning Monday	Morning Tuesday	Morning Wednesday	Morning Thursday	Morning Friday	Morning Saturday	Morning Sunday
Afternoon	Afternoon Monday	Afternoon Tuesday	Afternoon Wednesday	Afternoon Thursday	Afternoon Friday	Afternoon Saturday	Afternoon Sunday
Evening	Evening Monday	Evening Tuesday	Evening Wednesday	Evening Thursday	Evening Friday	Evening Saturday	Evening Sunday

Other (please specify)

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* 13. What is your desired start date?

Date / Time

Date