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Friendly Visitor Program

Volunteer Application

Part of the Long-Term Care Ombudsman Program

3910 Harry Hines Blvd., Dallas, TX 75219

Phone: (214) 525-6131

Thank you for your interest in our Long-Term Care Ombudsmen Program, Friendly Visitor Project at The Senior Source. Your willingness to serve our most often forgotten older and disabled adults living in Dallas County nursing homes and assisted living facilities is greatly appreciated and is essential to fulfilling our mission. Please complete the applicable form below to help us coordinate a meaningful volunteer experience for you.

NOTE: We do not participate in court-appointed community service.

Date of Application

Will you be volunteering individually or as part of a group?

IndividuallyGroup

Step 1: Your Contact Details

Group Name

Group Leader

First Name

Middle Name

Last Name

Primary Phone

Primary Phone Type

Secondary Phone

Secondary Phone Type

Date of Birth

Please enter the date in this format - MM/DD/YYYY

Gender

FemaleMaleOther

Mailing Address

Mailing Street

Mailing City

County

If not listed and in Texas, choose "Other - Texas." If not in Texas, choose "Out of State."

Mailing State

Mailing Zip Code

Step 2: Individual Volunteer Preferences

A criminal background check may be conducted by the facility staff if needed; however, this may vary due to COVID-19. Anyone under the age of 18 may require adult supervision.

Have you volunteered with The Senior Source before?

YesNo

What is your geographical preference
(select all that apply)?

Visit Type (select all that apply)

RemoteIn-Person

Travel Radius Preference

Step 2: Group Volunteer Preferences

Most facilities usually waive the background check for groups because you will serve in a public setting and not in resident rooms; however, this may vary due to COVID-19. Anyone under the age of 18 may require adult supervision.

Have you volunteered with The Senior Source before?

YesNo

Number in Group

If other, please explain.

Volunteer Age Range

Visit Type (select all that apply)

RemoteIn-Person

Your Organization/Group Type

What is your geographical preference
(select all that apply)?

Travel Radius Preference

Preferred Time Frame

10 am - 12 pm2 pm - 4 pmOther

If other, what is your preferred time frame?

Preferred Days of Week

How would you like to help? Check all that apply.

Collect new pre-approved personal care items and clothing for low-income residents living in Dallas County nursing homes and assisted living facilities.Create and send greeting cards, notes of encouragement, artwork to residents. (click here for examples) Record short senior-friendly videos. (educational or “How to” topics, exercise, music/entertainment, hobbies, travel, family, pets, etc.)Donate pre-approved snacks. (ship via online vendors is encouraged or make arrangements to personally drop off at facility) Donate pre-approved recreational/craft supplies. (ship via online vendors is encouraged or make arrangements to personally drop off at facility)Volunteer in-person to socialize with residents. (Varies per facility and subject to change)

Internal Use

Internal

FOR INTERNAL USE ONLY

DO NOT Send confirmation email to applicant.

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