MABVI Volunteer Application

Lend your sight for just a few hours each week or month; it will make an extraordinary difference in somebody’s life. Read a book or letter, help write bills, be a scribe for an aspiring novelist, help pen a memoir of a life well-lived, laugh, and enjoy the company of someone who will truly appreciate your presence and your vision. We will provide training on assisting someone who is blind or visually impaired and will match you with an individual in or near your community.

Volunteer Application

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Name(Required)

First Last

In order to best serve our consumers, we require volunteers to be consistent and commit to at least one year of volunteering. Are you able to give a commitment of one year or more of consistent volunteering with the MABVI one-to-one volunteer program?(Required)

Yes

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Volunteer Date of Birth(Required)

MM slash DD slash YYYY

Email(Required)

Phone(Required)

We Primarily use email to correspond with our volunteers, if you would rather a phone call please indicate below:

Yes, please call me instead of emailing

Volunteer Gender(Required)

Youth Volunteer (under 18)(Required)

Yes

If Youth Volunteer, who is the parent/guardian that you will be volunteering with

Volunteer Ethnicity

Employer or School (if applicable)

Does your employer match volunteer hours?

Yes

I am not sure

Which of the following tasks are you interested in doing?(Required)

Reading Mail

Clerical Tasks (such as organizing, filing, dictation)

Grocery Shopping and/or Errands

Walking/running as a sighted guide

Helping on the computer (order things online, typing, filling out forms)

Worcester County Only: Medical Escort Driver

Do you have a car that you plan to use for the volunteer opportunity (i.e. drive a participant)(Required)

Yes

If you are willing to use your vehicle, do you have auto insurance and an active driver's license?(Required)

Yes

If you plan to use your car for the volunteer opportunity, please explain (if applicable) any moving violations you have had in the past 5 years.

How far are you willing to travel to meet with a participant? (such as miles, towns, or travel time)(Required)

Preferred to be matched with? (gender)(Required)

Male

Female

No Preference

Preferred to be matched with (smoker)?(Required)

Prefer a match with a non-smoker

No Preference

Are you okay with pets?(Required)

Yes

If Not okay with pets, please indicate any specific type of pet, or particular concern

Do you have any access or mobility issues we should be aware of for your placement?

Please tell us some of your hobbies and interests. (If we can match people based on common interests that is a plus!)

Do you have any special skills that you would be willing to share as a skilled volunteer? (for example, graphic design, accounting)

Please indicate which (if any) languages you are fluent in besides English

Please indicate your availability to meet with your participant match, include days and times(Required)

How did you hear about MABVI volunteering?(Required)

Is there anything else you would like us to know about you, or the person you would like to be matched with?

Reference #1 (please indicate a professional reference we can contact for a character reference)(Required)

First Last

Phone number of professional reference(Required)

Email of professional reference(Required)

Reference #2 (please indicate a second reference we can contact for a character reference. This does not have to be professional, but please no family members)(Required)

First Last

Phone number of second reference(Required)

Email of second reference(Required)

Confidentiality Agreement Consent(Required)

I have read, understand, and agree to the following Confidentiality Agreement

PLEASE READ THE FOLLOWING CONFIDENTIALITY AGREEMENT CAREFULLY BEFORE AGREEING TO IT.

*CONFIDENTIALITY AGREEMENT: As a volunteer for the Massachusetts Association for the Blind and Visually Impaired (MABVI), I will have access to confidential information regarding some of the people we serve. I understand that information regarding the people we serve, and their families is confidential and private. I agree to perform my responsibilities and assigned tasks with proper regard for the privacy and confidentiality of the information which may be available to me in the performance of my duties. I will refrain from any mention of the confidential information to friends, associates, colleagues, or any other persons, except those persons at MABVI directly involved with the consumers who have the need to know such information in order to do their jobs. I understand that I may not identify any of the people served by MABVI in papers that I might write for school or in presentations I might make about my volunteer assignment. Please print your name in the box below to acknowledge that you have read, understood, and agreed to this policy.

Volunteer Contract Agreement(Required)

I have read, understand, and agree to the terms of the following VOLUNTEER CONTRACT

PLEASE READ THE FOLLOWING VOLUNTEER CONTRACT BEFORE AGREEING TO IT.
*VOLUNTEER CONTRACT: Responsibilities: Community Volunteers work on a one-to-one basis with individuals who are blind or visually impaired, assisting in a variety of tasks such as reading, clerical jobs and shopping. Qualifications: Volunteers must be dependable, responsible, empathetic and flexible. Volunteers must respect the confidentiality of consumers. Supervisor: Manager of Volunteer Services. Other Requirements: Each volunteer must attend an orientation/training session, complete an application, complete a phone/zoom interview, and submit a CORI. If an assignment needs to be terminated, the volunteer must notify the Manager. Volunteers are not permitted to drive a participant's car. Please print your name in the box below to acknowledge that you have read, understood, and agreed to this contract.

Images Consent

Yes you may use my images

No you may not use my images

PLEASE READ THE FOLLOWING POLICY BEFORE AGREEING TO IT. I hereby grant to MAB Community Services (“MAB”) / Massachusetts Association for the Blind and Visually Impaired the right to create, reproduce, display and disseminate worldwide and in perpetuity, in any traditional or electronic media format, my likeness and/or voice as shown in photographs and videos. Furthermore, I grant MAB and other organizations allowed by MAB the unconditional rights to use these images and videos, in whole or in part, in partnerships with commercial entities which may include, but are not limited to, the use of my likeness in advertisements in any media, including the MAB website (www.mabcommunity.org). I confirm that the images or videos were taken with my knowledge and consent. MAB has permission to use my name in corresponding captions or text that might appear with my image.

Name

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MABVI Volunteer Application

Volunteer Application

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