Volunteer Application
Please complete this application form if you are interested in becoming a Leukemia & Lymphoma Society, Nebraska Chapter volunteer. Please contact our office if you have any questions (402) 344-2242.
 
Demographic Information
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.
 
Availablity
Please indicate the days and times you are usually available to volunteer.
* Please check all available days & times:
 
Interests
By checking the interests or skills below, you help us determine the best volunteer opportunities for you. 
* Please choose the area(s) of interest:
* Please choose the campaign(s) of interest:
Why do you want to volunteer at LLS?
Please list reasons why you want to become a volunteer at The Leukemia & Lymphoma Society. 
Tell us more about yourself
Please list any talents or skills you would like to share as a volunteer.
Volunteer Experience
What type of volunteer experience have you had in the past? 
 
Confidentialty Agreement

I, serving as a volunteer for the Nebraska Chapter of the Leukemia & Lymphoma Society, agree to keep all information learned confidential. This includes any patient and family information such as names, addresses, phone numbers, diagnoses and current status. 

I understand this agreement and will abide by it. I will maintain this level of confidentiality even when I am no longer a volunteer of the Leukemia & Lymphoma Society, Nebraska Chapter.

As a volunteer for The Leukemia & Lymphoma Society, Nebraska Chapter, a nonprofit health organization serving individual clients and their families, I may become aware of personal and private areas of individuals lives. I agree to keep the following strictly confidential and will not copy, distribute or make available to others: 

- Any and all Society patient and family information and records, including and not limited to, names, diagnoses, treatment, personal life and status with The Society; and,
- Any manuals, marketing or promotional material, or lists related to The Leukemia & Lymphoma Society's programs, donors, participants or volunteers.

In emergency situations, when disclosure is necessary for the life or safety of our clients or another individual, the volunteer will discuss with his/her supervisor the need to breach confidentiality. This decision and action will be the responsibility of the chapter Executive Director or Patient Access, Education & Advocacy Manager. If possible and appropriate, the client will be informed as to the reason for the breach of confidentiality and what information will be shared. The staff person will document the conversation with the client or document why the conversation did not take place. Such documentation will be maintained in the client and volunteer file.

I agree to abide by this Agreement and maintain confidentiality during my volunteering for The Society and after my volunteering is complete. 
 
I understand no compensation for time and/or mileage will be granted. I understand this is not a contract and the volunteer relationship can be terminated at any time by either party with or without cause.

I understand that this signed form will become part of my volunteer file, and violation of this policy will be considered grounds for terminating my service to The Leukemia & Lymphoma Society.

By checking the agree box, it acts as my signature; I acknowledge that all the information contained herein is true and accurate to the best of my knowledge. 
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* Indicates Response Required