top of page

Friendly Visitor application

Please complete all the fields below and submit online


Phone number*

Email Address*

Date of Application*

Are you at least 20 years of age?*

Why are you interested in becoming a Friendly Visitor? Please describe.*

Have you had experience with aging parents, grandparents, etc? Please describe.*

What qualities do you have that you feel would help you relate well with seniors?*

Do you have any health or transportation problems that need to be addressed in order for you to participate in this program? Please describe.*

List some of your previous employment/volunteer activities that relate to seniors or homebound persons.*

bottom of page