DEAFBLINDRETREAT VOLUNTEERAPPLICATION
1.,
First NameLast Name
2., Apt #
Street Address
3., ,
City, State,Zip Code,
* 4.Email ____*REQUIRED
5.Primary Phone ()- Text Voice VP TTY
6.Secondary Phone ()- Text Voice VP TTY
7.Date of Birth //
8.Female Male Other _____
9.When was the last time you attended the Retreat?
Never 2015 2016 Other
10.Camp Arrival Time
Please check 1st, 2nd, or 3rd choice below.
Full Week: Sun Aug 27 at 4:00 PM – Sat Sept2at 9:00 AM
1st choice 2ndchoice 3rd choice Do Not Want
First Half Week: Sun Aug 27 at 4:00 PM – Wed Aug 30 at 2:00 PM
1st choice 2ndchoice 3rd choice Do Not Want
Second Half Week: Wed Aug 30 at 11:00 AM – Sat Sept 2 at 9:00 AM
1st choice 2ndchoice 3rd choice Do Not Want
11.My Deaf status is:
Deaf
Hearing
Hard-of-Hearing and can understand speech
Hard-of-Hearing but cannot understand speech
Volunteer Interpreter Application 20171
,
First NameLast Name
COMMUNICATION AND SKILLS
When matching volunteer interpreters with DeafBlindpeople, it helps us to know more about you.
12.Check all interpreting support duties that you can do:
1a.
PTASL
Tactile
Close Vision
Platform voice
Platform sign
1b.
PTASL
ASL
Signed language of another country
Signing in English order
Spoken English
1c.
Working with Developmentally Disabled DeafBlind people
Working with Hard-of-Hearing DB (DB may not know sign)
Typing with LVD/computer (communicate by typing largeprint)
Voice interpret for meal announcements
Platform copy for meal announcements
13.My dominant hand for writing and tactile signing:
Left Hand
Right Hand
Both
14.Do you plan to travel with a DeafBlind person? Yes No
a. Name of DeafBlind person:
b. If yes, do you want to be matchedthat person at camp? Yes No
15.Guide Dogs:
Yes, I am comfortable around guide dogs
No, I am not comfortable around guide dogs
16.Let us know your preferred Off-Shift.NOTE:We will try to give you preferred off shift, but it’s NOT guaranteed.If you havean importantreason for needing a certain shift off, contact us.
Morning
Afternoon
Night
17.Smoking:
I am a smoker
I am not a smoker
I can be matched with a smoker
I cannot be matched with a smoker
18.How tall are you?
5’ 4” or less
5’ 5” – 5’ 9”
5’ 10” or more
19.Check any duties you’d like to assist with:
Activity Idea ______
Arts and Crafts
Bikes (skilled tandem rider)
Braille Transcription
Computer (data entry, etc)
Lead Activity ______
Lifeguard (certified)
Snacks
Transportation (Examples: help with organizing or provide rides)
Water Activities
20.DeafBlind people do a variety of activities at camp. Which activities would you enjoy being matched with?
Physical activities (biking, jet ski, or swimming, etc.)
Calm activities (crafts, workshops, or board games, etc.)
Tours out of camp (Town, mall, state park or casino)
All
21.Which group of DBpeople are you comfortable working with?
Men
Women
Does not matter
22.Which DB people would you enjoy working with?
Old friends
New people
Does not matter
23.Name DeafBlind people you would LIKE to be matched with, if any. We will try to follow your preference, but cannot guarantee it. If you have an important reason to be matched with a DeafBlind person, please contact us.______
24.Name DeafBlind people you prefer NOT to be matched with, if any. __
25.Any unique notes about your interpreting duties? (Physical limitations? Carpal tunnel? Backproblems? Other?)______
26.Please tell us a little more about yourself. This information will help us to make the best matchups possible.______
27.How did you find out about the DB Retreat? Through friends? Internet? DB community? ______
28.Have you been to other DB retreats or camps before?If yes, where?
29. Do you have an active DB community in your area? ______
30. Do you have any friends (DB or sighted) who have also applied to the Retreat?______
31.What are your interests? ______
32.Comments: ______
33.What kind of SSP(Support Service Provider) experience have you had?ie. guiding, food shopping, read mail, etc. ______
34. Do you have experience using PTASL?
Very much
Some
Never
35. Do you have experience using tactile sign language?
Very much
Some
Neve
36.If this will be your FIRST TIME VOLUNTEER-INTERPRETING for Seabeck Retreat, please provideus with two references that are involved in theDeafBlind communities:
Reference 1:
,
First NameLast Name
Phone () - Text VP TTY Voice
Reference 2:
,
Last Name, First Name
Phone () - Text VP TTY Voice
PLEASE INCLUDE A PICTURE OF YOURSELF with your application! It can be a small passport size or any photo. It will help us remember who you are!
Volunteer Interpreter Application 20171
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First NameLast Name
HOUSING INFORMATION FORM
1. Do you smoke? Yes No
2. Will you share a room with a smoker? Yes No
3. Who are your preferred roommates?
,
(Name of person # 1) (Name of person #2)
4. Do you have difficulty with stairs? Yes No
5. Do you have difficulty with walking? Yes No
6. Will you bring your guide dog? Yes No
7. Will you share a room with a guide dog? Yes No
8. Do you use a wheelchair? Yes No
9.If yes, will you be bringing your own? Yes No
10.Do you use a walker? Yes No
11.IF yes, will you be bringing your own? Yes No
Volunteer Interpreter Application 20171
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First Name, Last Name
ADDITIONAL INFORMATION REQUEST FORM
If you would like any information listed below, call or send this page to the DeafBlind Program at Seattle Lighthouse for the Blind.
Visitor Registration Form
Volunteer-Interpreter Qualifications
DeafBlind Acceptance Process
DevelopmentallyDisabled DeafBlind people Information
Other, please specify:
There is no deadline for volunteers to apply. We accept qualified volunteer applications until we
are full. However, the sooner we receive your application, the easier it is for us to plan and
prepare the matchups.
You can email application to or mail to:
DeafBlind Program
Lighthouse for the Blind, Inc.
Attn: DB Retreat
2501 S. Plum Street
Seattle, WA 98144
Thank You,
DeafBlind Retreat Team 2017
DeafBlind Program
Lighthouse for the Blind, Inc.
Web:
Email:
Phone: (206) 452-7936
Fax:(206) 436-2234
Volunteer Interpreter Application 20171