Check and Connect Volunteer Application

  • Name: * Required
  • Address: * Required
  • Date Format: MM slash DD slash YYYY
  • Sex:
  • For the safety of our clients, Aging and Long Term Care of Eastern Washington conducts a Washington State Request for Criminal History Information on all volunteers having contact with our clients. By checking the box, I authorize Aging and Long Term Care of Eastern Washington to conduct background checks. * Required
  • DSHS Nondisclosure Agreement * Required
    I hereby confirm that I have read the DSHS Nondisclosure Agreement and agree to its terms.