Please complete this application form if you are interested in becomeing a St. Luke's hospice volunteer. Once you complete the form, click the submit button at the bottom.

Contact Information

Demographics and Personal

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Personal Refence

give two (2) personal references (do not include relatives):

Emergency Contact

Criminal History

St. Luke's completes a background check on all volunteers prior to serving at any of their facilities. Have you, at any age, ever been convicted of a crime (including withheld judgments, or other plea agreements, and any pending charges)? Crimes include: felonies, misdemeanors, traffic violations, etc. Answering "yes" does not automatically exclude you from volunteering.

Why do you want to be a Hospice volunteer?

Comfort Level

Do you feel comfortable being one-on-one with a terminally ill person? Please explain.

Explain your personal experience with death:

Have you experienced a recent loss?


Are you willing to commit to a training period up to 10 hours?

What is your current emotional support system?

What interests or hobbies do you have?

If you are accepted as a volunteer for St. Luke's, all information that you receive is confidential and not to be disclosed without the appropriate consent by St. Luke's. Any breach of confidentiality may result in termination of your service as a volunteer.