AAMOW Volunteer Application

Ann Arbor Meals on Wheels Volunteer Application

Demographic Information

Name Prefix

* First Name (Legal)

Middle Initial

* Last Name (Legal)

Suffix

Preferred First Name

Previous Last Name

Personal Pronoun

Personal Pronoun Not Listed

* Street Address

Apt #, Unit #, P.O. Box

* City

State

* Zip/postal

* Cell Phone (xxx-xxx-xxxx)

Alternate Phone (xxx-xxx-xxxx)

Race and Ethnicity

Sex

* Date of Birth (MM/DD/YYYY)

UMID number (if available)

Which of these best describes your connection to the University of Michigan? If two or more apply, choose the one you feel defines your role at U of M best.

If you are an employee or learner of Michigan Medicine (not University of Michigan campus), please upload a photo of your employee ID badge.

Citizenship and Visa Information

Citizenship

Are you in the U.S. on a Visa?

Visa Type

Visa - other

Visa Exp. Date

NOTE: Please upload a copy of your visa and at least one form of supporting documentation.

Visa (Upload Image)

Visa Supporting Documentation #1 such as I 20, I 94, or DS 2019 forms.

Employment/Education (If Relevant)

Employer Name

Phone (Work)

High School/College Name

Primary Emergency Contact

* First Name & Last Name

* Relationship

* Primary Phone

Secondary Phone

* City

State

Secondary Emergency Contact

First Name & Last Name

Relationship

Primary Phone

Secondary Phone

City

State

Volunteering Information

Below are the current volunteer opportunities with Ann Arbor Meals on Wheels.

Delivering Meals: Delivery of fresh prepared meals to AAMOW clients and provision of a safety/wellness check for clients in their homes
Yard Clean-Up: Spring and Fall yard clean up at client homes

Please select the volunteer opportunities you are interested in:

Select if you are volunteering with one of the specified groups

How did you hear about Ann Arbor Meals on Wheels?

If you have any special requests or needs related to your volunteering, please list below.

* What interests you about volunteering for Ann Arbor Meals on Wheels? Please click below.

Are you volunteering to satisfy a requirement?

If yes, please explain.

AAMOW welcomes children ages 5-18 of approved volunteers to accompany their parent/legal guardian during meal delivery. Approval from the AAMOW office must be obtained prior to having minors accompany you when volunteering. Do you have minor children between the ages of 5-18 that would like to volunteer with you?

References

Please give three character references that can respond to our inquiry about you. References can be work, academic, or personal contacts that have known you for a minimum of 6 months.

Reference #1

* Reference Full Name (First Last)

* Reference Email:

* Reference Phone:

Reference #2

(copy)

* Reference Full Name (First Last)

* Reference Email

* Reference Phone

Reference #3

* Reference Full Name

* Reference Email

* Reference Phone

Authorization for Criminal Records Check

Have you ever been convicted of a misdemeanor or felony?

Are there any felony charges pending against you?

Is there anything in your history you want to tell us before we run your criminal background check? If yes, please describe below.

Attestation

As a volunteer of Ann Arbor Meals on Wheels, I understand that the University of Michigan/Michigan Medicine is not responsible for any damage sustained to my vehicle or injuries incurred during the meal delivery process, and my personal automobile and/or health insurance will be responsible.

* Check box for agreement

* Type Your Full Name

Certification

I certify that my answers are true and complete to the best of my knowledge. I agree that this information has been verified and references may be contacted by AAMOW or Michigan Medicine Volunteer Services.

I, the undersigned, authorize the University of Michigan, on behalf of Michigan Medicine, to conduct a criminal history check and review of the Federal Exclusion Lists. These checks will be performed to evaluate whether I am qualified to volunteer at the University of Michigan.

I understand that Michigan Medicine will contract with an outside vendor to conduct these investigations utilizing names and identifiers to determine the existence of any arrest resulting in conviction and furnish a response to Michigan Medicine.

I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for volunteering will not be processed further.

Misrepresentation of facts constitutes cause for separation from Volunteer Services.

* Check box for agreement

* Type Your Full Name

* Date

Thank you for your interest in volunteering with Ann Arbor Meals on Wheels! Please click the button below to submit your application. Upon submission of your application, please allow five (5) business days for processing.