American Cancer Society-Northern California Chinese Unit
Volunteer Information Form
Please print this form and fax over: 510 797-0698

Name: Mr./Mrs./Ms.

Address: ___________________, __________, CA ___________
(Street) (City) (State, Zip)

Phone: (H)_____________ (O) ______________

Fax: (H)_____________ (O)_______________

Email Address: ____________@_____________

Has already been an ACS volunteer? Yes__ No__ , if you have already been an ACS volunteer, please briefly describe your current service in ACS:

Your specialties or interests?

Primary language ? Mandarin __Cantonese __Taiwanese __English __Other __(specify)

Available time? Weekday __Morning __Afternoon

Please number the following services from 1 to 16 according to your will:

( ) Office: need to work in office, choose half day from Monday to Friday.

( ) Paperwork: copying, filing, mailing , contacting any activities……….

( ) Phone service: picking up the phone, providing the information the callers request, contacting with any activities and Patient Data Entry. Have to speak Mandarin and Cantonese mainly.

( ) Publishing community resources and book files.

( ) Computer Word Processing: Typing in English and in Chinese, entering data and designing any pamphlets and table. You can choose work at home or in office, but the software you use have to be compatible with the software used in office. Contact office for details.

( ) Website Design: To set up website about cancer information written in Chinese.

( ) Charity: participate any activities for charity like Chinese New Year Karaoke , Relay For Life, and greeting card sales.

( ) Transportation service: picking patients up into the hospital (usually on the day on Monday through Friday) or attending the class of cancer help groups.

( ) Translating languages for patient in hospital (usually on the day on Monday through Friday)

( ) Home visit: Visiting patients in hospital, their homes, and elderly homes, listening to them and help relieve their pain.

( )Guiding patients' family: Have to be a past patient, visiting patients before, or having a medical background.

( ) Reach to Recovery: Have to be breast cancer patient self.

( ) Health service: There are two free health examinations each year, need professional nurse, doctor, nutritionists and site-workers.

( ) Editing: once each quarter, including planning, articles collecting, typing, revising and publishing.

( ) Translator: translating English medical information into Chinese.

( ) Public education: Holding any cancer and health activities. They are usually held on Saturdays. The work including planning, advertisement, organization and reception.

Have you or your family members ever had cancers? Yes __No__ , Type________________

Willing provide cancer experiences? Yes ___No___

Note: