Senior Companion and Foster Grandparent Volunteer Application

To be eligible to receive the $3.00 tax-free stipend and other reimbursable benefits, you must be income eligible. Federal guidelines determine that Senior Companion Volunteers can make 200% (or less) of the current poverty level. Please note that the total amount of your income excludes medical expenses.

Certifications:

I hereby state that I offer my services as a volunteer for the NWICA Senior Companion and/or Foster Grandparents Program. I understand that I am not an employee of the project, NWICA, or the Federal government.

I understand that in my capacity as a senior companion/foster grandparent volunteer, I may come into contact with confidential information. I agree to protect this information to the best of my ability and not to disclose it during or after my service as a volunteer has ended. Volunteer drivers must have proof of insurance and a valid driver’s license to drive while serving. I understand that if I use my personal vehicle in my volunteer services, I will keep in effect a valid driver’s license and auto liability insurance equal to or greater than the minimum requirements of the State of Indiana.

I verify the above information is true, and by submitting this application, I acknowledge and agree that my volunteer position with NWICA can be terminated with or without cause, and with or without notice at any time, at the option of wither NWICA or myself.

I authorize NWICA to solicit information regarding my character, general reputation, previous employment, and similar background information, including a background check through the Indiana State Police, a National Sex Offender Registry search, FBI clearance and to conduct any and all references. I understand that my position is contingent on eligibility determined by the results of these background checks. I understand that if I have been convicted of murder or if I am required to register as a sex offender, I am ineligible to serve in this program.

I hereby release all parties and persons connected with any such request for information from all claims, liabilities, and damages for any reason arising out of the furnishing of such information. I further understand that copies of this application will be kept in a volunteer file as well as sent to those NWICA programs and departments in which I have indicated interest.

Volunteer Code of Ethics

In serving as a Senior Companion/Foster Grandparent Volunteer, I will be serving vulnerable seniors and children. I realize that I will be subject to a code of ethics. I will assume certain responsibilities and will be expected to be accountable for all activities pertaining to my volunteerism. Therefore, I promise to:

➢ Act in accordance with the policies and procedures of the Senior Companion/Foster Grandparent Program.

➢ Act as an ambassador for the Senior Companion Program, bridging the gap between isolation and companionship.

➢ Act as an ambassador for the Foster Grandparent Program, supporting and/or facilitating access to services and resources that contribute to improved academic, social, or emotional development outcomes for children.

➢ Serve clients to the best of my ability, and always in the interest of increasing their independence and happiness.

➢ Treat all clients with respect and consideration at all times.

➢ Respect the confidentiality of clients and their families.

➢ Maintain the family as a key support system where there is an option.

➢ Maximize the quality of like of my clients by providing quality and appropriate support.

➢ Not use the client’s possessions for my personal use.

➢ Not accept money or tips from my client or their family, nor will I do extra work for clients in exchange for money.

➢ Not consume alcoholic beverages nor use medicine or drugs (except for treatments of a medical problem) while volunteering.

➢ Bring an attitude of open-mindedness and positivity.

➢ Be willing to receive training, supervision, and an annual evaluation.

➢ Understand my own needs and limitations, and not overextend myself or commit to activities that impede on my health.

➢ Be clear about my role as a senior companion and/or foster grandparent volunteer, and establish boundaries with clients is need be.

➢ Have a professional attitude towards my volunteerism.

➢ Be accurate and timely with my paperwork.

➢ Keep program staff informed of any changes to my clients or self.

Violation of any program policies may result in disciplinary action or termination.