Better Together Volunteer Application

If you are interested in becoming a mentor, please complete the fields listed below and click "Send Now" at the bottom of the page.

If a couple, family or group are volunteering together, every person over the age of 18 must complete an application.

If you do not receive a confirmation email within 48 hours confirming the application went through successfully, please contact LSS Better Together at 605-221-2403.

Please also complete the attached release for a criminal background check. Note: Both the application and release forms must be completed in order to apply to become a mentor.

Contact Information

Gender
Best Contact Method
Prefer call in
Have you ever been convicted of a drug charge?
Have you ever been convicted of a criminal offense?
Have you ever been convicted of abuse, neglect, or assault?
I am volunteering
I am comfortable working with a senior who lives alone.
I am comfortable working with a senior with limited mobility.
I am comfortable working with a senior on daily living tasks (grocery shopping, sorting mail, etc.)
I am comfortable going to community events with a senior.
I am comfortable transporting a senior in my personal car.
I am comfortable with a senior having a pet.
I am comfortable with a senior smoking or living with a smoker.
I am comfortable with a senior having limited room in their home or struggling to keep their home clean?
I am comfortable with a senior having some memory issues.
I am comfortable with a senior dealing with a chronic condition.


Referral Information

How did you hear about LSS Better Together? Check as many as apply and describe below


Matching Information

I am available the following days/times:

I would like to meet:
I am interested in participating in monthly events organized by LSS?


References

Please list three non-family references. Please provide complete information to expedite your application.

1st Reference


2nd Reference


3rd Reference




Volunteer Agreement

Please check yes or no to confirm your understanding of the program guidelines. Thank you for carefully reading before completing.

By checking yes, I hereby state that if accepted as a mentor, I agree to abide by the rules and regulations of LSS Mentoring Services. I affirm that:

The information I have provided in the application may be verified, and I give permission to Lutheran Social Services of South Dakota to make inquiry of others concerning my suitability to act as a volunteer.
In the course of volunteering as a mentor, I may be dealing with confidential information, and I agree to keep said information in the strictest confidence. This means that I will not discuss my senior’s personal problems publicly or with others. If I need help, I will seek the assistance of LSS. I understand that this confidentiality does not apply to suspicions I may have about abuse, neglect, illegal activity, or suicide. If these issues arise, I will immediately contact program personnel.
The relationship between volunteers is an “at will” arrangement, and that it may be terminated at any time without cause by the volunteer, the senior, or Lutheran Social Services.
I agree to attend orientation.
I agree to abide by the policies and guidelines of the program. I understand that failure to do so may result in termination of the mentoring relationship.
I understand that all activities shall take place only during mutually agreed upon times.
I will volunteer approximately four hours per month. In the event that I cannot attend as scheduled, I agree to contact my senior in advance of the scheduled meeting.
I am willing to commit to one year in the program and will be asked to renew my participation in subsequent years.
I understand that I will be able to meet in public locations throughout the community.
I will participate in an additional training, submit to additional background screening (fingerprinting, auto insurance, etc).
By clicking here, I certify that all the information I have provided in the application above is accurate.

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