Volunteer Information

Before filling out this form please refer to "Open Volunteer Positions" PDF. If you do not have this PDF, please email healingalsvolunteers@gmail.com and one will be emailed to you.

Name *

First

Last

Email *

Phone number (no spaces or hyphens include country code if not US or Canada) *

Time Zone *

City *

State/Province/Department *

Country *

ALS Status *

• PALS
• CALS (Main caregiver)
• FALS (Family member/close friend)
• Suspected ALS not yet diagnosed
• Other

Type of ALS (You or your PALS) *

• Limb Onset
• Bulbar Onset
• Both
• PLS
• Other

Month and Year of Diagnosis (You or your PALS) If not yet diagnosed write NA. *

Month and Year of Symptom Onset (None if Other) *

How much time do you have per week to volunteer? *

• 1 hour
• 2-3 hours
• 4-6 hours

Do you currently work for pay or volunteer elsewhere? Click all that apply. *

• Full-time paid work
• Part-time paid work
• Part-time volunteer outside Healing ALS
• Flexible hours (paid or volunteer)
• Work outside the home
• Work at home
• On disability or retired, no paid or volunteer work outside Healing ALS.

Limitations: Can you speak/type/do you have a computer? *

Major Skills *

Major Passions *

Of the open positions on the PDF, which are you most interested in? Please put 1st, 2nd, 3rd, choice and include if you would like more than one position. *

Tell us anything you want, your situation, goals, what you love, etc.

Submit