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:
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Last name:
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Middle name:
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Title:
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Dr.
Mr.
Mrs.
Ms.
Nickname:
Street 1:
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Street 2:
Street 3:
City:
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State:
Choose
AK
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CA
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WI
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WY
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Zip:
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Home phone:
Cell phone:
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Email address:
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Preferred contact (email, text, call):
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Demographic Information
Date of birth:
Month
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1917
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Gender identity:
Choose
Female
Male
Non-binary
Prefer not to say
Prefer to self-describe
*
Education:
Choose
Associate degree
College degree
Doctoral degree
High school
Master's degree
Some college
Trade/Vocational school
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How did you hear about us?:
Choose
AARP/Create the Good
ALZSD newsletter
ALZSD website
Craigslist
Facebook
Flyer posted in community
Friend
Indeed
Internet search
Internships.com
KPBS radio or TV
LinkedIn
NPWorks
Other
Other organization
School/professor
TV news
Twitter
Union-Tribune
Volunteer fair/career expo
VolunteerMatch
*
Other languages:
Choose
Arabic
Chinese
Farsi
French
German
Hebrew
Italian
Japanese
Korean
Laotian
Portuguese
Russian
Spanish
Tagalog
Vietnamese
Ethnicity:
Choose
American Indian or Alaska Native
Asian Indian
Black/African American
Chinese
Filipino
Guamanian or Chamorro
Hispanic/Latino
Japanese
Korean
Multi-racial
Native Hawaiian
Other Asian
Other Ethnicity
Other Pacific Islander
Samoan
Vietnamese
White/Caucasian
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.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning:
Afternoon:
Evening:
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
*
From:
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Feb
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2027
2028
2029
2030
2031
2032
*
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
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Year
2022
2023
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2025
2026
2027
2028
2029
2030
2031
2032
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I would like to serve up to:
*
hours:
Choose
Daily
Monthly
One time
Weekly
*
Assignment Preference:
1st choice:
Choose
Companion Volunteer
Education Assistant
Receptionist
Support Group Leader
Tech Team Volunteer
Virtual Intern/Service Learning Volunteer
Youth Alzheimer's Ambassador
2nd choice:
Choose
Companion Volunteer
Education Assistant
Receptionist
Support Group Leader
Tech Team Volunteer
Virtual Intern/Service Learning Volunteer
Youth Alzheimer's Ambassador
Emergency Contact
First name:
*
Last name:
*
Street 1:
Street 2:
City:
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
Home phone:
Work phone:
Cell phone:
*
Email address:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Sibling
Son
Spouse
Supervisor
*
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
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