Thank you for your interest in volunteering with Genesis Hospice. Once submitted, your application will be reviewed by the Volunteer Coordinator and you will receive a follow-up call or email to discuss next steps.

Please call 563-421-5113 for assistance in completing this form. 

Any field with an * is required information.



Contact Information


Tell us more!

We want to know more about you! Please fill out the information below.



Emergency Contact

All volunteers must have an emergency contact listed


Volunteer Opportunities


Availability

Please indicate the days and times you are usually available to volunteer.



How did you hear about volunteering with us?


Work and Volunteer Experience


Additional Information

Do you have a record of founded child or dependent adult abuse and/or have you ever been convicted of a crime in Iowa or any other state?



I Agree

I understand and agree that submitting this application does not guarantee volunteer placement in any particular location at Genesis Hospice. I understand that if I am selected as a volunteer, the placement, terms, and conditions of my volunteer service will be determined by Genesis Hospice.

I agree to adhere to Genesis volunteer policies and procedures, including:
- I understand that I need to pass a Criminal History Record check in order to become a volunteer
- I understand that I must pass a child abuse and dependent adult abuse check in order to become a volunteer
- I understand that I must comply with Genesis Health System's COVID-19 and Influenza vaccination requirements in order to volunteer with Genesis Hospice

By submitting, I attest that the information I have provided on the form is true and accurate. I understand and agree that falsification of this or any other information is grounds for denial of this application or immediate termination from the volunteer program.