Zen Hospice Project Volunteer Training Application Kol Haneshama by wuyunqing

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									                                                                                                              Zen Hospice Project


                                         Volunteer Training Application
                                     Kol Haneshama: Jewish End of Life Care+
                                               Seeking Volunteers
                 in collaboration with Jewish Home of San Francisco and Zen Hospice Project *

Thank you for your interest in Kol Haneshama: Jewish End of Life Care volunteer program.

Our volunteers provide practical, emotional and spiritual support to men and women of all ages with cancer,
AIDS, or any other terminal illness. Each volunteer receives thorough training, is closely supervised and is
supported by a community of peers. No prior experience in health care is necessary; we each have the
capacity to empathetically care for another.

An application form is attached. The Bay Area Jewish Healing Center screens all applicants. After returning a
completed application, you will be notified by the Healing Center, and told whether or not you will be
scheduled for an interview. Acceptance into the program is based on your application and interview. Once
the training is filled applications will be held for the following training.

You may return your completed application anytime. Once we fill a training group, applications will be
held over for the following training.

There is a fee of $200 to defray the costs of this training. If this creates a financial hardship please let us
know as we may be able to assist you. You may also want to explore the option of having either an
organization or friends and family sponsor your training.

If you are able to participate in the next training, we encourage your thoughtful and reflective completion of
this application. Full participation in each of the six days of training is required. In addition to the training,
new volunteers will be asked to make a one year commitment to serve one 5-hour shift per week and attend
support group meetings one evening of each month.

If you have any additional questions about the volunteer program, please contact Rabbi Elliot Kukla at
(415) 750-3440 or ekukla@ioaging.org



                                            Upcoming Training Dates

                                                            To be determined.


                                       + Bay Area Jewish Healing Center is a beneficiary of the

                      Jewish Community Federation of San Francisco, the Peninsula, Marin and Sonoma Counties.
  Partial funding for Kol Haneshama is provided by the Walter and Elise Haas Fund, the Maimonides Fund of the Jewish Community
                 Federation of San Francisco, the Peninsula, Marin and Sonoma Counties, and Sinai Memorial Chapel.

    * Zen Hospice Project’s collaboration is funded in part by grants from the PacifiCare Foundation and the E. Rhodes and Leona B.
                                                           Carpenter Foundation.
                                                                                 Zen Hospice Project


                        Kol Haneshama: Jewish End of Life Care
                            Caregiver Volunteer Application

Date______________________

Name ________________________________________                  Home Phone: __________________

Address________________________________________ Work Phone: __________________

Email: _________________________________________

Date of Birth ____________What is your cultural identification? _________________________

How did you hear about the program? Flyer         Advertisement       Internet      Friend
Other____________

Do you have a car at your disposal? ___

Are you presently working/studying?____ Full       or Part-time

What is your occupation/course of study _____________________________________________

Do you have previous volunteer experience? (Please describe briefly.)



What do you look for in a volunteer experience?



Do you have special skills such as (i.e. health care, counseling, massage, foreign languages, cooking,
art, music, massage, or other skills you think might be helpful)? Please describe briefly:
  New volunteers will be asked to make a one year commitment to serve one shift per week and to attend a support
                                    group meeting one evening of each month.
                             Volunteer shifts times will vary depending on assignment.

Please specify times during the week/weekend that you may be available. Flexibility is important.
Weekdays:        Morning              Afternoon            Evening
Weekends:        Morning              Afternoon            Evening
How would you describe your general health?


Do you have any allergies?


Do you have any physical limitations?



Please describe the nature of your Jewish identification.




Have you recently experienced a loss through death? _____ If so, please describe briefly:
Please include any spiritual practice that you engaged in.




Have you spent time with someone very sick and/or dying? _______ If so, please describe briefly:




Have you ever seen a dead body? __________ attended a funeral? _____________________
Tell us why you want to be a Hospice volunteer. Please respond to the following questions
as thoughtfully and completely as you can, exploring your feelings and intentions. Be
certain to cover all the points indicated. You may respond to each question individually or
attach an essay.

1. What is your understanding of hospice and end-of-life care?




2. How do you see your role as a hospice/end-of-life volunteer?




3. Please describe any personal experience with serious illness (your own or that of someone close
to you), and its effect on you.




4. Hospice works with people with cancers, AIDS, dementia, as well as other illnesses and concerns.
Describe your feelings about what it may be like for you to be with people with serious physical
limitations or altered appearances resulting from their illness or its treatment.




5. Volunteers provide emotional and practical support for people experiencing living and dying with
a terminal illness. What kinds of patients or situations would you anticipate having the most
difficulty working with and why?




6. Describe your personal experience with grief and your feelings about the grieving process.
7. What are your feelings about and understanding of pain management?




   8. It is important for caregivers to have good emotional support in their own lives. What are
      the sources of emotional support for you?




   9. Describe at least one situation in which you provided a compassionate and listening presence
      to someone in need.




   10. Why have you chosen Kol Haneshama: Jewish End of Life Care Project over other
       volunteer opportunities?




   11. How do you feel about the time and energy required to volunteer with Kol Haneshama?




   12. Do you anticipate anything which may interfere with fulfilling the one year commitment ,
       e.g. family obligations, possible plans for relocation, future study?



   13. Any additional thoughts that come up for you in completing this application, or anything
       else you would like us to know?
Once again, new volunteers will be asked to make a one year commitment to serve one shift per
week and to attend a support group meeting one evening of each month.


Thank you for considering the Kol Haneshama: Jewish End of Life Care as an opportunity for
volunteering and service. We appreciate the time and thought involved in completing this
application. Please return this application to:


                                 Bay Area Jewish Healing Center
                                 3330 Geary Blvd, 3rd Floor West
                                    San Francisco, CA 94118
                               (415) 750-4197 fax (415) 750-4115
                                   jewishhospice@ioaging.org
                                  www.jewishhealingcenter.org

								
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