Volunteer Application

Thank you for your interest in volunteering with the Foundation. After you complete this form, you will receive an email detailing the next steps in becoming a CCF volunteer. If at any point in the application process you would like to speak to our Volunteer Coordinator, please contact Claire Condrey at claire.condrey@cholangiocarcinoma.org or via phone at 888-936-6731 x28.

About You

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email(Required)

Date of Birth

MM slash DD slash YYYY

Please describe your relationship with cholangiocarcinoma(Required)

Patient/Survivor

Family Member of Patient

Friend of Patient

Caregiver

Medical Professional

Other

If applicable, please share the date of diagnosis (for yourself or your loved one).

Skills & Experience

Last School/University Attended

Course of Study

Highest Level Completed

High School

Associate Degree

Bachelor’s Degree

Graduate or Professional Degree

Some College

Other

Prefer Not to Answer

Which languages can you speak fluently? (check all that apply)

Arabic

English

French

German

Italian

Japanese

Mandarin

Russian

Spanish

Swedish

Employer

Position

Your interests (check all that apply)

Administrative Support

Research Advocacy

Fundraising

Marathons

Mentoring

Policy

Social Media

Availability(Required)

(number of hours per week for volunteering)

Demographics

Volunteer demographics can help the foundation qualify and/or complete for grant funding opportunities. If you are comfortable sharing the below information it will be used for this purpose alone. It is the policy of the Cholangiocarcinoma Foundation to provide equal opportunities without regard to age, race, color, religion, gender, sex, national origin, disability, veteran status, or any other characteristic protected by law.

Gender

Male

Female

Non-Binary

Transgender

Prefer Not to Answer

Are you of Hispanic, Latino or Spanish origin?

Yes

How would you describe yourself?

African-American

Asian

Caucasian

Native American

Native Hawaiian or Pacific Islander

Prefer Not to Answer

Other

Agreement(Required)

Yes, I understand

I understand that this is an application for and not a commitment or promise of volunteer opportunity.

I certify that my answers on this application are true and complete to the best of my knowledge.

I certify that I have not withheld any information that would unfavorably affect my application for a volunteer position.

I understand that information contained on my application will be verified by CCF.

I understand that misrepresentation or omission of facts on this application may be cause for rejection of this application or dismissal as a volunteer.

Confidentiality Agreement(Required)

Yes, I understand

I understand that volunteers of the CCF have an ethical and legal obligation to respect the privacy of all stakeholders including board of directors, staff, volunteers, and members of the patient and medical communities.

This agreement applies to all volunteers associated with and/or involved in the activities or affairs of CCF:

I understand that I may be given access to confidential and/or proprietary information to the extent necessary in order to perform my duties as a volunteer with the CCF.

I shall not, at any time either during or subsequent to this participation with CCF make unauthorized disclosures or unauthorized use of any information that is considered to be proprietary or confidential by the CCF except where required for an authorized business purpose. Proprietary information includes, but is not limited to, all information, documents, notes, files, records, computer files or similar materials whether in written, oral or electronic form. This includes information protected under any applicable state or federal privacy laws.

I shall not disclose any information obtained in the course of my volunteer placement to any third parties without prior written consent from the organization. This includes but is not limited to information pertaining to financial status and operations such as budget information, donations of money or gifts in kind, salary, or information pertaining to patients, staff or other volunteers.

If I am unsure about the confidential nature of specific information, or whether specific information may be protected under state or federal law, I will ask the staff member supervising my actions for clarification before disclosing the information.

When I cease my participation as a volunteer with the CCF, I will return all CCF-related information and property that I have in my possession, including but not limited to documents, files, records, manuals, information stored on a personal computer, cell phone, and equipment or office supplies.

Failure to comply with the confidentially policies of the organization may result in disciplinary actions, including the dismissal of the volunteer. I understand the above and agree to uphold the confidentiality of these matters both during and following my volunteer service with the organization.