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About Dementia
Getting a Diagnosis
Get Involved
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AzATT in the news
Newsletter
Issue #6 2020
Caregiver Stories
Useful Websites
Awareness Dates
World Alzheimer's Month
2017 Regional Non- Latin Caribbean Conference
Shop
Alzheimer’s Disease International (ADI) 34th International Conference
General Information
*
Indicates required field
1. Name
*
First
Last
[object Object]
2. Age Group
*
18-24
25-34
35-54
55+
3. Mailing Address
*
4. Phone (H)
*
Phone Home
Phone (C)
*
Phone Cell
5. Email
*
6. Present Occupation
*
7. Our volunteer opportunities may require some local travel. Please indicate if you are able to: Use public transport
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Yes
No
OR use own vehicle
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Yes
No
8. Are there any physical or mental health issues that you feel we could support you with when volunteering?
*
Yes
No
9. How did you hear about Alzheimer’s Association of Trinidad and Tobago?
*
Attended a meeting
Flyer
Media (print/social media/radio/Tv)
Other
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Education/ Experience
Which education level did you complete?
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CXC/GCSE
A-level
Tertiary Education
I have past experience with Alzheimer’s disease.
*
Yes
No
What is your interest in or experience with Alzheimer’s disease?
*
Do you have any volunteer experience, if yes with which organization(s) and what were you doing?
*
What do you hope to gain from your volunteer experience with us?
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Volunteer Interests
I would like to volunteer in the following area(s) of the Association’s activities:
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Caregiver support
Public relations
Event Planning
Education
Transportation
Administration
Fundraising
Outreach
Other please state
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Availability PM
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Which days are you available on evenings?
Availability AM
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Which days are you available on mornings?
Select One
*
Occasionally
One-time projects
Call as needed
Emergency Contact
Contact Name
*
Relationship
*
Phone (H)
*
Phone (C)
*
References
Please list at least two professional and/or personal (not including relatives) references with complete address and phone number below. References remain confidential.
Name
*
First
Last
Relationship to volunteer
*
Name
*
First
Last
Relationship to volunteer
*
Address
*
Address
*
Telephone (H) and (C)
*
Telephone (H) and (C)
*
TERMS AND CONDITIONS
During the course of my volunteer assignment I may have access to confidential information about the Alzheimer’s Association of Trinidad and Tobago, its directors, staff, members, persons with dementia and their families. I understand that such privileged information must be treated in the strictest confidence.
I accept that a breach of this confidentiality may result in a termination of my volunteering with the Association.
I understand the Association reserves the right to request a character of reference depending on the nature of my volunteer assignment.
I understand that it is incumbent upon Association to provide an evaluation of a volunteer’s service and assignment of volunteer activities when appropriate.
I understand that I must first seek permission from an authorized person to take any photograph, audio recordings, and/or video recordings.
I also understand that in order to volunteer, I may be expected to participate in an orientation and/or training program.
Choose Any
*
I agree to the above terms and conditions.
Submit
Home
About Us
About Dementia
Getting a Diagnosis
Get Involved
Become a Member
Donate
Contact Us
AzATT in the news
Newsletter
Issue #6 2020
Caregiver Stories
Useful Websites
Awareness Dates
World Alzheimer's Month
2017 Regional Non- Latin Caribbean Conference
Shop
Alzheimer’s Disease International (ADI) 34th International Conference