Volunteer/Intern Application

Please complete this application form if you are interested in becoming an Alzheimer's San Diego volunteer or intern. Once you complete the form, click the Continue button at the bottom.

FOR INTERNATIONAL APPLICANTS: Enter your actual address and phone number in the open field under the "Demographic Information" section and use the following address for the application: 6632 Convoy Court, San Diego, CA 92111. Use phone number: 858-966-3296.

Name and address

First name:

Last name:

Middle name:

Title:

Nickname:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Preferred contact (email, text, call):

Demographic Information

Date of birth:

Gender identity:

Education:

How did you hear about us?:

Other languages:

Ethnicity:

Have you committed a felony?:

Is your service court-ordered?:

Why would you like to volunteer with Alzheimer's San Diego? Do you have any knowledge of or experience with Alzheimer's disease?

Availability

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

Emergency Contact

First name:

Last name:

Street 1:

Street 2:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

Clinical Trials & Research

Would you like information about local clinical trials and research? A worldwide quest is under way to find treatments to stop, slow and even prevent Alzheimer’s disease – much of that work happening right here in San Diego. Volunteering for a clinical trial is one of the best ways to support research!

Yes, I would like information:

Acknowledgement:

I acknowledge that I have personally completed this application and that the facts contained in the application are true and complete to the best of my knowledge. I understand that any misrepresentation or omissions may disqualify me from further consideration for volunteer work, if discovered at a later date.

I Agree