Banner

TimeBank-Application-Form-for-Individuals

Section 1: Member Information

    Member Information

    1. Do you speak English?

    Do you speak another language?

    2. Gender

    3. Ethnicity


    4. Employment Status

    5. How comfortable are you using any online meeting software (e.g.: Zoom, Microsoft Teams, Google Meet, etc.) to participate in a virtual meeting?

    Very comfortable. I use online software to participate in virtual meetings all the time.Somewhat comfortable. I use online software to participate in virtual meetings a couple of times, but I’m still not very familiar with it.Somewhat uncomfortable. I have never used any online software to participate in virtual meetings, but I am eager to learn how to do it.Very uncomfortable. I have never used any online software to participate in virtual meetings and I am not willing to learn how to use it.

    6. What is your preferred meeting software?

    Services I can Offer I would like to Receive
    Technology
    “How to operate a tablet/ a cell phone/ Zoom” webinar
    Health and Wellness
    Virtual stretching/ Tai Chi/ yoga/ meditation classes
    Hobbies
    Virtual knitting/ crafting/ painting classes
    Virtual baking/cooking classes
    Participate in virtual live music event hosted by Senior Center
    Virtual game/ book club (facilitator sharing their screen)
    Housing Assistance
    Provide suggestions on basic home repair solutions
    Help with connecting to a trustworthy handyman via telephone, text, or online
    Provide support on yard work, gardening, or basic snow removal
    Community Assistance
    Admin support for Age-Friendly Glen Cove (e.g.: attending virtual community meetings, creating surveys and lists)
    Admin support for time banking
    Admin support for other organizations
    Teaching
    Tutoring/mentoring (e.g.: teaching language, finance, art…):
    Test prep: (circle subjects)

    Service Checklist (Check off all that apply)

    Personal References (Personal references must be 21 years of age or above.)