Wayfinder Application

Welcome, and Thank You for Your Interest in Becoming a Patient Choices Vermont Wayfinder

We are truly grateful that you are considering joining our compassionate community of Wayfinders. Your interest in supporting education and advocacy around Medical Aid in Dying (MAiD) and end-of-life choice in Vermont under Act 39 means so much.

This application form will help us understand your background, availability, and the type of volunteer role that feels most meaningful to you. Whether you're drawn to providing direct support through the Helpline, assisting as a Wayfinder, participating in Outreach, or contributing in another unique way, we value your time, experience, and willingness to help.

Please take a few moments to complete the form below. Once submitted, a member of our team will review your information and follow up with you directly.

Thank you again for stepping forward. Together, we are making a difference for Vermonters facing end-of-life decisions.

Warmly,
The Patient Choices Vermont Team

Wayfinder's Application – Patient Choices Vermont

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Interest and Background

Occupation(s) *

Employer (if relevant) *

How did you learn about PCV? *

Why are you interested in supporting this work? *

What background, experience, or skills would you bring to this work? *

Do you have experience caring for or supporting someone who was terminally ill? *

Is there anything else you’d like to share? *

References

Please provide the names and contact information for two individuals outside your family, who can tell us about your ability and/or potential limitations in doing this work.

Comment *

Disclaimer/Signature

“I authorize Patient Choices Vermont (PCV) to contact the people I have named as references. All information is confidential, and I release from liability anyone giving or receiving this information. I understand that any omission or misrepresentation of fact in the application process may result in the denial or termination of a volunteer role with PCV.”

I agree to the terms above. *

Yes

Typed Signature *

Today's Date *

Submit

​Welcome, and Thank You for Your Interest in Becoming a Patient Choices Vermont Wayfinder

​Wayfinder's Application – Patient Choices Vermont

​Interest and Background

​References

​Disclaimer/Signature

Welcome, and Thank You for Your Interest in Becoming a Patient Choices Vermont Wayfinder

Wayfinder's Application – Patient Choices Vermont

Interest and Background

References

Disclaimer/Signature