Your name

Street address

City

State/region

Postal Code

Telephone

Your email

---I have Autoimmune Encephalitis and was diagnosed in (date)I am currently being treated for my AE withI am in recovery from Autoimmune EncephalitisI am a Family Member/ Loved One/ Caregiver of an AE Warrior (please note relationship) Your Answer

Availability
MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Hours I am usually available:

How much time will you have for initial training?

I work or previously worked in the Medical field.
YesNo

Type of medical Expertise/Specialty/Title and years of experience (type N/A if not applicable):

Profession prior to AE or Current Profession:

Indicate which of any of the below skills you have
Computer skills, Webinar, Videographer, Graphic designerWriting, Research, Forms, GraphsMedia, Technology, Marketing, Advertisement, Fundraising, Grant writing, Customer Service, Public Relations, Organizing Conferences, Chaplin, Special Education with expertise in 504 plan and IEPs, Volunteer Director, Social Worker, Special Events coordinatorEducation Knowledge
Additional Skills

Please explain your interest in volunteering for IAES:

What skills do you have that you feel will be helpful as a volunteer? Include, clerical, administrative, professional, talents, hobbies and interests where skills can cross over to assets: