Early Stage Support Group Facilitator Application

It is the policy of this company to provide equal volunteer opportunities to all qualified persons without regard to race, religion, creed, color, national origin, gender, marital status, veteran status, sexual orientation, disability, age, genetic information or any other factor protected by federal, state or local laws as well as other applicable government regulations and execution orders.

1. Please fill out the information below.

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City/State/ZIP:

 

    

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What's this?

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Question - Required - We have programs currently in 2 cities. In which city will you participate?


 

Employment

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(Maximum response 255 chars, approx. 5 rows of text)

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Education, Professional Licensure/Certifications & Trainings

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Question - Required - Education/Degrees
Please make between 1 and 5 selections from the choices below.

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Question - Required - When would you be able to start?




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(Maximum response 255 chars, approx. 5 rows of text)

 

References 

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I understand that this is an application and not a commitment or promise of volunteer opportunity.

I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge, and I authorize the investigation of all statements and references contained within this volunteer application that may be necessary in arriving at a decision for a volunteer position.  I understand that misrepresentations or omission may be cause for my immediate rejection as an applicant for a volunteer position with the Alzheimer’s Association or my termination as a volunteer.

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