Long-Term Care Ombudsman Application

Thank you for considering dedicating some of your time to volunteer as a Long-Term Care Ombudsman for SNAP. Please fill out the volunteer application below, and we will reach out to you shortly to review next steps.

First Name*

Last Name*

Mobile Number*

Email*

Mailing Address*

City*

State*

Zip Code*

Previous Work Experience

Previous Volunteer Experience

Please provide three (3) references. Include their full name, relationship, primary phone, and email.*

Have you been employed by a Long Term Care Facility?*

Yes

Do you have experience with Word Processing (ex: Word, Google Docs, etc.)?

Yes

Do you have experience with spreadsheets (Excel, Google Sheets, etc.)?

Yes

Do you have experience with email (Gmail, Hotmail, Yahoo, MSN, Outlook, etc.)?

Yes

Languages spoken and/or written (other than English)?

What other skills or experience do you have that may benefit you in your role as an Ombudsman?

Why do you want to be an Ombudsman?*

How did you learn about this volunteer opportunity?

Due To The Confidential Nature Of Ombudsmen Work, Electronic Communication Must Be Protected. Is Your Main Email Address Password Protected?*

Do you have a valid Driver’s License for your state of residence?*

Are you willing to devote four (4) hours per week to the Ombudsman Program visiting an assigned facility?*

This field should be left blank

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