QHCS Volunteer Form

Quality Home Care Cares About Our Community!

Please be honest with us when you fill out this application; it’s the first step towards becoming a volunteer with QHCS. Other steps include talking with you and your references, and the on-site volunteer training. During this process, please ask questions and share your concerns so we can determine if joining the team at Quality Home Care is an appropriate decision for you.

Please click on the links below to view information on the Volunteer poisitons we have available at this time.

The fields marked with (*) are required.
*Your Name
*Your E-mail Address
Your Street Address
Home Phone  
Other Phone
Are you currently employed?
 Yes No
 Yes No
If yes, please list employer and occupation
Are you a student?
 Yes No
If yes, please list name of school or college
Have you ever been convected of a crime
 Yes No
If Yes, year of conviction

Please Note: Before you become a volunteer with QHCS, we are required to submit a Criminal Offender Record Information (C.O.R.I.) for our personnel files.



How did you hear about QHCS? 

Why do you want to volunteer with QHCS? Is there anything you’d like to learn or gain while with us?

Have you volunteered anywhere else?       
 Yes No
If yes, please list the most recent
Name of orgaization
How would you like to volunteer with QHCS?

Is there any population you are particularly interested in working with?

Is there any person or group you would feel uncomfortable working with?

Ideally, what would you love to do as a volunteer with QHCS?
Making A Commitment

Some volunteers can commit to working three hours or five hours per week, while some only a few days each month, and for special events, even once per year. Tell us what kind of commitment you can make.

I am available...


I can commit to volunteering for months.
(Three-month minimum is requested)

Skills and Knowledge

What knowledge do you have about HIV/AIDS, harm reduction, substance abuse, mental health, and/or homelessness?

Have you ever participated in an HIV/AIDS 101 training?
 Yes No

Please list any skills you have (Microsoft Office, data entry, telephone work, clinical background, research, cooking, etc):

What do others tell you is a strength of your personality?

What do you think is one weakness of your personality?
Please provide us with the name and phone number of one reference. She/he will be called by the Program Coordinator. Please be sure to let your reference know they are listed on this application, so they are prepared.
Reference Name
Reference Phone
How does this person know you? (supervisor, counselor, etc.):

Who can we contact in case of an emergency?

Questions / Comments