Extra Hands for ALS

Extra Hands for ALS - Los Angeles/Orange County Chapter - Student Registration

Thanks for your interest in Extra Hands for ALS. This form is for student volunteers. If you are interested in registering as an Extra Hands Mentor or as an ALS Family, please click here:

We're looking forward to meeting you!

Contact Information

First Name *

Last Name *

Email: *

Phone Number *

(xxx) xxx-xxxx

Cellphone Number

(xxx) xxx-xxxx

Street Address

City

State

Zip

Identity

Race:

Gender:MaleFemale

Birthdate: *

Your School

School Name *

Street Address

City

State

Zip

Phone Number *

(xxx) xxx-xxxx

Community Service Faculty Member

What grade are you in?

What is your grade point average?

Emergency Contact Information

Full Name *

Relationship To You

Email: *

Phone Number *

(xxx) xxx-xxxx

Cellphone Number

(xxx) xxx-xxxx

Motivation

Why would you like to volunteer with Extra Hands? *

If you know or have known someone with ALS, please explain.

If you know or have known someone with a terminal illness, please explain.

What are some things you do to cope with stress?

Do you have any other experiences, training or education that make you a good candidate to be a volunteer?



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