Faith in Action of
Marathon County, Inc.
630 Adams Street
Wausau, WI 54403
Phone (715) 848-8783
Fax  (715) 848-3325
Email
Faith in Action of Marathon County
Faith in Action brings together people of many faiths to help their neighbors in need.
Faith in Action volunteers shop, cook, drive or just check in on the millions of Americans with long-term health needs.
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* Required Field
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 Date of Birth:
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 Name:
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 Gender:
 Male
 Female
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 Phone Number:
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 Street Address:
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 City, State, Zip:
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 Emergency Contact:
Phone:  
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 Relationship to you:
Church Affiliation if any:
Languages Spoken:          English           Hmong           Spanish       Other:
Living Arrangements:         Living alone           w/Spouse              w/Other:
Pet(s) in Home?          no           yes; If yes, please specify:
Someone smokes inside home?    yes    no
Health Status
Physical Conditions:
Vision:   Hearing:     Communication:  
Social Contacts:     Many   Some   Few
Other Help Being Provided (relatives, friends, agencies):  
Volunteer Match Information
Please list your hobbies, recreational interests, special skills and interests,
etc.  Is there something specific you’d like a volunteer to share with you?
Questions, comments, or feedback:
Services Requested

___ Transportation (to or from appointments)        
___ Phone calls (routinely for reassurance)
___ Companionship/Friendly Visiting                
___ Respite Care (2-4 hr. break for caregiver)
___ Shopping with/person to do shopping for you        
___ Minor Home Repair (no electrical or plumbing work)
___ Light Housekeeping (mop, dust, windows)        
___ Meal Preparation (occasional)  
___ Assistance with Paperwork (letters, bills, etc)        
___ Yard Work (grass cutting, raking, trim work, shoveling snow)
Confidentiality Agreement

Faith in Action of Marathon County, Inc. is partially funded by grants. Certain
demographic information is needed on many grants, so we would ask for your
cooperation in providing the following information. Please be assured that all
personal information will be kept strictly confidential.

Race:             White/Caucasian                         Asian        
 Hispanic or Latino                         American Indian/Alaska Native
 Black/African American                         Native Hawaiian/Pacific Islander
 Other race/two or more races                 unknown

How many people in your primary household?   What is the total annual
household income?

Volunteers are taught that they should not share your name or any information
about you that would identify you to persons not involved with your care, without
your permission.

To help us meet your needs, we request that you give permission to authorize
program staff, community agencies, and volunteers to share information, as
needed, about your health status, history, and current needs so we can best
serve you.
Request for a Volunteer
I will do my best to find a
Faith in Action volunteer
who can assist you.
Thank you for your interest in receiving support from a Faith in Action Volunteer.  

In order for me to work on finding a volunteer to meet your needs, I ask that you answer
these questions below and fill in the information requested.  When complete, please click
the  'Submit" button.

needs.
needs.


In the meantime, if you have any questions, please feel free to contact me at the Faith in
Action office.  The phone number is 848-8783.   
Connecting People in Need with People who Care!
Volunteers from all walks of life assist their elderly and disabled neighbors
with simple tasks that allow them to live independent in their own homes.
Hours:
Mon - Thurs
10:00 am-
2:00 pm