APPLICATION TO BECOME A VOLUNTEER COMPANION
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Name
__________________________________________________DOB____________
Address ______________________________ City __________________
Zip_________
Phone
(h)___________________________________(w)__________________________
SC Driver’s License # _______________
Car Insurance Co. ____________________________ Policy
#_____________________
Emergency Contact ______________________Phone
(h)__________(w)_____________
What method of transportation will you use when meeting with your
Companion?
Describe yourself and what you like to do for fun.
What do you think makes a person a good friend?
Tell why you would like to be a Volunteer Companion.
What times are good for calls (to and from your companion)?
What are good times to do activities with your companion?
If you have had experiences with a person with a disability, please
describe:
Have you had a relationship with a person with mental retardation or
autism?
Please sign: ___________________________________________ Date:
_________________
Please indicate permission to be photographed
Yes ______ No ______
Please return to:
The Arc of SC
Community Companions Program
1823 Gadsden Street
Columbia, South Carolina 29201
Applications may also be faxed to (803) 779-0017.