Private and Confidential

STUDENT VOLUNTEER APPLICATION FORM

Thank you for your interest in Volunteering with Age UK Mid Hampshire. Volunteers play a vital role in the work with older people that we serve in Winchester, Andover and the surrounding area. The information you provide will be stored in confidence under the provision of the Data Protection Act and will be held securely and confidentially.

Title: / Mr / Mrs / Ms / Miss / Other
First Name:
Family/Surname:
Address:
Postcode:
Telephone No: / Mobile:
email: / Providing an email address saves us time and costs in dealing with applications, so an email address is very helpful please
DoB / age:

To ensure we can offer you the appropriate support, do you have any health issues or medical conditions that you think we should know about?

It’s important that we put you in a role that you enjoy and are suited to. The questions below will help us get an initial idea but you will be the one to make the choice once you know exactly what’s involved in each role.

How much time are you willing/able to give/volunteer?(eg: Mondays, Weekdays only, negotiable etc.) / Hours per week / days per week/month. This does not commit you today, it’s just to help us understand your circumstances.
Do you have use of a vehicle? / Yes / No
Would you be willing to use this vehicle as part of your voluntary role? / Yes / No Like most voluntary organisations we don’t provide transport for volunteers. Volunteers who work outside of our offices may need to use a car to carry out their role, in which case, travel costs are reimbursed.
Do you hold a full driving licence: / Yes / No Even if you don’t own a vehicle, on occasion the ability and willingness to drive another vehicle may be helpful. Would this be a problem?
Are you able to use normal office type computers and applications? / Yes / No
How competent are you with computers?

Our Volunteers generally undergo induction training with us at Age UK Mid Hampshire.

What areas would interest you in volunteering? (Tick as many boxes below as you wish)

Enablement Service (mentoring older people to enable them to remain safe, independent and in their own homes)

Mini Bus Driver (within your local area)

Information and Advice (I&A) (to help elderly citizens fill out forms etc)

Office Based (to help office staff as an assistant to fill in forms, field phone calls, answser queries and take messages)

Lunch Club (to assist with serving lunches and to help lunch club members, to assist when events, games and activities are arranged and to generally chat to the members and help where necessary)

Supporting the Help-at-Home Co-ordinator with tasks relating to the elderly receiving Help-at-Home

Befriending (to visit people at home to have a cup of tea and a chat) (students must be 22 or older please)

Lasting Power of Attorney Support adviser (Winchester)

Other – please specity:

About You and Volunteering:

Valuing our volunteers is key so we would like to know a bit about you, your interests and previous experience. This helps us meet your needs and expectations as a volunteer and allows us to assign you to a role which makes the most of your expertise and time.

Do you have any previous volunteer experience? If so, please tell us about it. / Previous experience is NOT required, but it’s helpful to know.
Please tell us what you would like to offer and achieve by volunteering with us? / We want to offer you a fulfilling volunteering experience, so to help us meet your needs, we like to understand what volunteering with us would mean to you.
Please tell us about any hobbies, skills or previous experience you feel would assist us to know. / We find that many people have lots of skills and knowledge which, whilst not directly related to a role, may become helpful in the future.
How did you hear about this volunteering role? / We advertise for volunteers so it’s helpful to know what works!

What has attracted you to the idea of volunteering with us? (Tick as many boxes below as you wish)

Helping older peopleLearning new skills

Making new friendsBuildingpersonal confidence

Other – please specity:

Have you been convicted of a criminal offence at any time? Yes No
If ‘Yes’ please give details, including date(s) and nature of offence(s) please use a separate sheet if needed.

Data Protection:

It is important for us to record our volunteers’ contribution and also to ensure that we comply with Data Protection legislation. We keep records of volunteers to comply with Safeguarding requirements and of course to be able to liaise with our volunteers and to generate statistics on numbers of volunteers supporting us in the different areas to helps us secure funding.

I hereby give consent and permission for Age UK Mid Hampshire to record personal information in support of my volunteering activities should I commence as a Volunteer with the charity. I understand that this data may be kept and maintained in computer and/or manual format. I understand that such information is required with regard to Safeguarding of the charity’s service users; for my contact details to be available at Age UK Mid Hampshire and to ensure that my service to the charity is recorded. We will use the information you have supplied to communicate with you in line with Data Protection guidelines and will not pass it on to any third party.

Signed: / Date:

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