Meals on Wheels Volunteer Form

Name*
First Middle Last
Email*
Enter Email Confirm Email
Address*
Street Address City State ZIP Code
Home Phone
Work Phone
Cell Phone
How did you hear about TCOA volunteer opportunities?*
How would you like to receive reminders about your upcoming volunteer shifts? Check all that apply. (Meals on Wheels only)
- Text
- Email
- Phone Call
You may change your preference at any time by contacting your Meals on Wheels volunteer coordinator.
Volunteer Experience (Agency/Organization Name and Volunteer Role)
Personal References (Name, Email, and Telephone number for Two or More Individuals Other Than a Relative)*
Employment Background (Present and Past Employers and Positions Held)
Volunteer Positions*
- Nutrition Program (Meals on Wheels): Drive your own car or go with a partner and deliver lunches to clients who are unable to prepare their own meals. Most volunteers drive one lunch hour a month, others prefer to deliver more often. Mileage reimbursement is available. Routes take about 1 hour.
- Nutrition Program (Dining Sites): Help dish up food at dining sites across the tri-county area. Also needed are individuals to help with educational and entertainment programs for the sites.
- Nutrition Program (Central Kitchen): Help prepare food or package individual meals.
- Senior Proxy Project: Proxy Project volunteers deliver boxes of food and fresh produce to seniors' homes, assist in the office, or help with outreach.
- Medicare/Medicaid Assistance Program: Meet with clients and take hotline callers who have questions and concerns about Medicare, medical bills, long-term care insurance, Medigap and Medicaid.
- Workshop Facilitators/Trainers: Facilitate evidence-based workshops or programs by leading groups and sharing health and wellness information. Specific topics may include caregiver support, caring for someone with dementia, the fear of falling, chronic pain, and diabetes management. Training is provided.
- Special Events: Plan and/or participate in the annual Meals on Wheels Golf Outing and/or TCOA Dinner and Auction. Solicit sponsors, secure prizes and items for live and silent auctions, assist with raffle sales, and/or volunteer on event day.
- General Administrative Volunteer: Participate in general office duties such as data entry, stuffing envelopes, and/or placing phone calls to gather and update resource information.
- Friendly Reassurance Calls: Receive a list of older adult TCOA clients that you call about once per week. The purpose of the call is a friendly chat to reduce social isolation.
- Propose your own Volunteer Role:
Propose Your Own Custom Volunteer Role*
Consent for Information*
- By checking this box, I understand that Tri-County Office on Aging conducts criminal history background checks on all volunteers, and that additional information may be requested in order to review my driving record and "conviction only" criminal history. I understand that the information provided here and any additional information obtained by Tri-County Office on Aging will be kept strictly confidential.
- By checking this box, I agree to maintain confidentiality in the event that I come into contact with any personally identifiable information and/or protected health information of clients.
- By checking this box, I give permission to Tri-County Office on Aging to contact my references using the contact information I provide on this form.
Background Check Consent Form
I give my permission for the following information to be used by Tri-County Office on Aging to secure information regarding my "conviction only" criminal history. I understand that the information provided below will be kept confidential and used for the sole purpose of checking my criminal history records every three years. Any information obtained by Tri-County Office on Aging will also be kept strictly confidential.
Name*
First Middle Initial Last
Date of Birth*
MM slash DD slash YYYY
Sex*
- Male
- Female
Race*
Ethnicity*
- Hispanic or Latino
- NOT Hispanic or Latino
Have you lived outside the state of Michigan in the last 7 years?*
- No
- Yes
If yes, we will contact you for additional information.
Alias names used, including previous married names or maiden name:
Signature*

By typing your name above, you agree that your electronic signature is the legal equivalent of your physical signature.
Date*
MM slash DD slash YYYY
Thank You
TCOA staff attempt to reply to volunteer inquiries within 1-3 business days. If you have not heard back from TCOA within a week, please check your spam/junk folder, then call 517-887-1487. If you would prefer to mail in your application and background check consent form, please see the downloadable link below.
Comments
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Volunteer Qualifications

Volunteer Job Description

Background Check Consent Form

Thank You