'Advocates for Life' Volunteer Program Questionnaire

Please complete this questionnaire if you are interested in becoming a volunteer in Donor Alliance 'Advocates for Life' volunteer program. Once you complete the form, click the submit button at the bottom.

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