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Weekly phone conversation for isolated seniors 60+

 

BEFORE SIGN UP:

  • Each senior carefully matched 1:1 with one of our trained volunteer phone buddies.

  • Senior and their volunteer phone buddy will decide together on a scheduled day/time for their weekly phone conversation.

  • Senior will need to be able to answer the phone on that scheduled day/time. Conversations are typically around 30 minutes. 

  • Senior benefit from our program when they agree to and can understand that they will be having weekly phone conversations with their matched volunteer.  

  • HIPAA compliant. All calls documented. All volunteers screened, trained, and supervised.

  • Phone program only. Volunteers do not connect with seniors via email, Zoom, Facetime, social media, or in person.

  • All responses to this form are confidential. We NEVER share this information outside of our organization.

  • At this time, we're only taking clients from Clearfield County.

 

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Seniors Birthday
How did you hear about us
Social media
Newspaper
Agency Staff
Internet search
Meals on Wheels
Community Service Agency
Topics you enjoy
ECONOMIC CATEGORY: Please indicate if senior fits into any of these categories. While financial status is NOT a determining factor to participate in the program, we are required to collect this information for grant funding purposes.
Medicaid Recipient
Subsidized Housing
Snap/Food Stamps
None of the Above
SELF-ASSESSMENT: These questions are based on the UCLA Loneliness Scale and help us evaluate our program impact. All info is confidential, as always. How often do you feel alone or lonely?
Often
Some of the Time
Hardly Ever
How often do you feel that you lack companionship?
Often
Some of the Time
Hardly Ever
How often do you feel forgotten or left out?
Often
Some of the Time
Hardly Ever
What is senior's living situation? *
I live alone
lives with a caregiver, a family member, or a roommate
Is senior filling out this form themselves?
Yes
No, I am a social worker, family member, agency staff, therapist, or someone else connected to the senior
Intake/Office Staff
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