Elder Rehab at the JCC Needs a Few More volunteers/interns!

Tucson Jewish Community Center

Elder Rehab Student Application Form 

(Submit to: Sharonmerlearkin@gmail.com. Questions? Call Dr. Arkin  520-603-2912)

Date Submitted                                                         Date/Time Received            

Name__________________i_____Available Fall 2018_______  Spring 2019__________Age___

 Specify time periods when you are available.if you know.

2 hour time periods available on:   Tues. betw 10- 6:_______       Thurs. betw 10-6:_______      

Mon. betw 2-6_______    Wed. betw 2-6_______   Fri. betw 2-6_______   Sun. betw 10-6_______

Email                                                               Phone Number

Current CPR? ___________     (certificate or proof of registration for course required before start of program.) Languages spoken__________

Semester as of Fall 2l018 (2nd,  4th, etc.)       Major _______________

Career Goal                                    Grad School?                                       

Local Address                                                                 Zip Code                         

Living arrangement (alone, w/ roommate(s), etc.)                                                    

Parents’ Names:                                                                                                  

Parents’ (Your permanent) address                                                                         

Parents’ Phone Number:                             Email:                                                  

Do you have a car or access to a car?                  License?        Car Insurance?          

Can you get parents’ OK to drive another student or your senior partner in your car?    

Describe any experience working out on gym equipment, such as treadmill, stationary bike, weight machines or other physical activities (i.e., yoga, dance, sports, etc.).

Name_______________________Date__________

Do you have a pet or is there some other interest, craft, or musical activity that you could lead ?

Describe.

Describe any previous volunteer experience:

Previous work experience:

 

Do you have a family member or friend who had or has Alzheimer’s or a similar disorder involving memory loss and communication difficulties?

If yes,

Describe                                                                                                             

Reasons for wanting to be an Elder Rehab volunteer or intern

Submit to: Sharonmerlearkin@gmail.com. 

Questions? Call Dr. Arkin  520-603-2912