'Advocates for Life' Volunteer Program Questionnaire

Thank you for your interest in volunteering with Donor Alliance! Please complete this questionnaire to allow us to get to know you. Once you complete the form, click "submit" at the bottom. Once we've received and reviewed your application, you will be sent an e-mail with next steps from our Volunteer Coordinator. Thank you again for your interest in our volunteer program, Advocates for Life!

Name and Contact Information

Your Connection to Organ & Tissue Donation

Recipient/Transplant Candidate:

Your Transplantation Date:

Transplant Center/Location of Donation:

Your Loved One's Passing Date:

What did your loved one donate?:

Specify your affiliation with organ and tissue donation (ie. Recipient of, transplant candidate for, relative of a recipient of, donor family member & was your loved one an organ and/or tissue donor, and what is your relation to the recipient or donor if you are a family member?)

Computer Knowledge & Other Applicable Skills

Volunteer Opportunity Interests

Personal Story

Please share your personal story or interests with us as it relates to donation and/or transplantation.

Please type your personal story or interest as it relates to donation/transplantation here or send it to me in an email (Email: volunteers@donoralliance.org). Thank you!

Emergency Contact Information

First name:

Last name:

Home phone:

Cell phone:

Email address:

Relationship:

Additional Enrollment Requirements

You will be required in-person to sign the Release of Liability, Privacy and Confidentiality Statement, Conduct Agreement and Background Screening Authorization for Advocates upon joining Donor Alliance's "Advocates for Life" volunteer program.

I Agree