NHS- Volunteer Proforma

Volunteer Proforma

Experience of Care Volunteer
Title
Name
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Contact Number*
Gender
Gender Identity*
Are you now or have ever defined yourself as Trans?
Age*
Ethnic Origin*
Do you consider yourself to have a disability?*
Dietary Requirements*
Dietary Requirements (add comments)
Accommodation required*
Accommodation (add special requirement comments)

Special requirements ie: access, disability etc. for the hotel (if applicable) and venue
Travel requirements (if applicable)
Train travel required?
Train Travel Seating

Outward & Return Preferences (forward facing, window, quiet carriage etc)
Nearest Train Station
Travel Mobility requirements
Your Role with the NHS*

Job Role
Organisation*
Area of Expertise
Background & Experience
A brief resume of your background and experience with the NHS. (negative or positive)
Participation in a Leadership Academy programme

Add Name of Programme
Date of Attendance
Any Programme Feedback?
Volunteering

If you are involved in any Volunteering, please identify your role:
Volunteering
If you are involved in any Volunteering, please identify your role:
Volunteering Experience
Details of any Volunteering experience (either within the NHS or other organisations)
Feedback & Suggestions
Feedback and suggestions for improvement within the NHS, with regards involvement of Volunteers?

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