Please complete this application form if you are interested in becoming a volunteer with The ALS Association Iowa Chapter.

If you have questions about The ALS Association, volunteering, or submitting this application, please contact the volunteer coordinator at 515-369-2572 or

Contact Information

Demographic Information

The information you provide will help us better understand the make up of our volunteers.


Volunteer Opportunities

Which volunteer opportunities are of interest to you? Please check all that apply.

Note - The 2019 Spring Day of Caring is open only to employees of Hills Bank and Wells Fargo in Cedar Rapids, Wells Fargo in Iowa City, Wells Fargo in the Quad Cities and Iowa Wild, Principal Financial Group and Wells Fargo in Des Moines.

Family Assistance Program

If you are interested in becoming a family assistance volunteer, please check everything with which you would be willing to help.

Time Commitment

When are you generally available to volunteer? How frequently would you like to volunteer?

Skills and Experience

What skills and experience do you have?


Some of our volunteer positions require specialized skills or experience. Please check all that apply.

Emergency Contact

In the event of an emergency, whom should we contact?


Please provide contact information and email addresses for two professional references* we can contact about your application to volunteer. References will not be contacted until after your interview with ALS Association staff.

*Family Volunteer Assistance Program and Equipment Loan Program Only - Volunteers applying to be a part of these programs will go through a screening process to participate. For more information about this process, please contact Sarah Lettow, Engagement Coordinator, at


The information I provided on this application is accurate and current. I authorize The ALS Association Iowa Chapter to verify this information and contact the references I listed as part of the volunteer screening process.