Long-Term Care Ombudsman Volunteer Application

The Office of the Long-Term Care Ombudsman provides Certified Volunteer Ombudsman for Kansans living in nursing, assisted and home plus facilities. They serve as the voice of the resident, working to make the system responsive to their needs and wishes. To do that, they investigate the resident's concerns and then work with facility staff and/or others, as appropriate, until these concerns have been resolved. The services provided are free and confidential for the resident. Once trained, volunteers are asked to regularly visit residents in their assigned facility and helping to resolve issues. Thank you for your interest in becoming a volunteer Certified Ombudsman - we look forward to reviewing your application!

Contact Information

Preferred Means of Contact

Applicant Information

If so please list
How did you learn about the Long-term Care Ombudsman Program?

Do you have access to transportation?

Are you able to commit to completing 36 hours of initial training, 1-3 hours of volunteer service per week and 18 hours of ongoing training a year?

Work History

Please tell us about your work experience, including paid and volunteer positions.

If you are currently employed, please list your current job first. Use the remaining spaces to describe other work experiences (paid or volunteer). Or you may attach/upload your resume.

Upload Resume

Position #1


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Please provide two references not related to you and their contact information

Reference #1
Reference #2

Note: To ensure the safety of our clients, volunteers, and the communities we serve, applicants will be asked to consent to a criminal record check. We will ask you to complete a separate form of authorization.

Authorization and Certification
I certify that the information I provided in this application is true, complete, and accurate to the best of my knowledge. I authorize the Office of the Kansas Long-Term Care Ombudsman to contact the references named above with regard to my application to become an Ombudsman volunteer.  I also authorize the persons referenced to provide information in connection with my application.