Volunteer Information Please enable JavaScript in your browser to complete this form.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 *FirstLastEmail *Phone number (no spaces or hyphens include country code if not US or Canada) *Time Zone *City *State/Province/Department *Country *ALS Status *PALSCALS (Main caregiver)FALS (Family member/close friend)Suspected ALS not yet diagnosedOtherType of ALS (You or your PALS) *Limb OnsetBulbar OnsetBothPLSOtherMonth 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 hour2-3 hours4-6 hoursDo you currently work for pay or volunteer elsewhere? Click all that apply. *Full-time paid workPart-time paid workPart-time volunteer outside Healing ALSFlexible hours (paid or volunteer)Work outside the homeWork at homeOn 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