Speech Language Pathology & Audiology Spring 2016
Student Academic Service-Learning Internship Packet
Staten Island Sites
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Carmel Richmond Healthcare and Rehabilitation Center
(For speech pathology students)
88 Old Town RD
Staten Island, NY 10304
Agency Contact
Please email yessenia.gonzalez11@my.stjohns.edu to schedule your service with
Carmel Richmond Healthcare.
Yessenia Gonzalez, VISA Office
yessenia.gonzalez11@my.stjohns.edu
718.390.4189
Site Contact:
Vera Cicero: Director of Therapeutic Recreation
Main Line: 718.979.5000
ecicero@archcare.org (Please e-mail first)
Nature and Purpose of Agency
The mission of ArchCare is to foster and provide faith based holistic care to frail and
elderly people unable to fully care for themselves. Through shared commitments,
ArchCare seeks to improve the quality of the lives of those individuals and their families.
Tasks Available for Students
All volunteers are welcome to participate in activities that provide our residents with
companionship and stimulating conversation. Students will be transporting residents to
Rehabilitation sessions. During those sessions clients will be working with speech
pathologists and occupational therapists, etc.
Time Requirements
Students must complete 15 hours of service.
Student Awareness/Special Instructions
 The Office of Academic-Service Learning will schedule an orientation with
Carmel Richmond prior to the students beginning their service. The date is still
to be determined.
 Students should bring the following to the orientation:
o Attached application and cover page completed and signed
o Copy of your medical records indicating a current PPD test. You may pick
up your medical records in the nurse’s office in Campus Center, B17, free
of charge. Please bring the attached release of medical records form to
the nurse in the Campus Center, B17. Copy of your medical records will
be provided free of charge
o Proof of current flu shot. If you did not get a flu shot, you will be given a
mask at the Center to wear during your time serving there. g in the library
room 101.
 Dress code: No tank tops, no ripped jeans, no open toe shoes.
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
Students must be informed that there is to be NO FOOD and NO FLUIDS given
to any resident at any time. Also, if students are not sure of any situation at
anytime during the visit to reach out to the nurse or administrator at the home
Agency Directions
Public Transportation
Go south on Howard toward Park Ln, turn left onto Park Ln, keep moving ahead on
Oakland Ter, Keep moving ahead on Laurel Ave, turn right onto Gordon St, turn left
onto OSGOOD Ave, turn right onto Vanderbilt Ave and take S76. You will be on it for 12
stops and get off at Richmond Rd-Dellwood Rd. Start out going southwest on Richmond
Rd towards Dellwood Rd, turn left onto Old Town Rd
Go south on Howard toward Park Ln, turn left onto Park Ln, keep moving ahead on
Oakland Ter, turn left onto VanDuzer St and take S74. You will be on it for 14 stops and
get off at Richmond Rd-Dellwood Rd. Start out going southwest on Richmond Rd
towards Dellwood Rd, turn left onto Old Town Rd
Driving Directions
Head southwest on Howard Ave toward Park Ln, turn right to stay on Howard Ave, turn
left onto Clove Rd, turn left to stay on Clove Rd, continue straight to stay on Clove Rd,
slight right to stay on Clover Rd, take the 1st right onto Richmond Rd, slight right to stay
on Richmond Rd, turn left onto Old Town Rd
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VOLUNTEER REQUIREMENTS
Please fill out the Application and Health Assessment Form.
Read the HIPAA booklet regarding Privacy & Confidentiality.
Sign and date the HIPAA Privacy Certification Form.
Volunteers born after 1957, are required to provide proof of immunizations for
MMR - Measles, Mumps & Rubella.
You must have a current PPD and a TB test completed in the current year. This is
required annually.
Volunteers born prior to 1957, are required to have a current PPD test completed
in the current year. This is required annually. You must also provide An MMR
titer from your physician.
Please call or e-mail Elvira Cicero to make an appointment for an interview as
well as a tour of the Facility.
Please note the following:
- PLEASE DO NOT LEAVE YOUR APPLICATION AT
THE FRONT DESK.
- BEFORE YOU SUBMIT YOUR APPLICATION,
PLEASE CALL ELVIRA CICERO FOR AN APPOINTMENT
THEN A TOUR OF THE FACILITY CAN BE PROVIDED.
- YOU CANNOT VOLUNTEER UNLESS ALL PROOF OF
IMMUNIZATIONS ARE SUBMITTED.
Thank you for your cooperation
Elvira Cicero, Director of Volunteers
Phone #: (718)–668-8509
e-mail: ecicero@archcare.org
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Carmel Richmond HC & RC
APPLICATION FOR VOLUNTEER SERVICE
Name:________________________________________
Date:_________________
Address:______________________________________
Telephone:____________
Age:____ Date Of Birth:_____ Sex:_______ Marital Status:________
Emergency Contact: ___________________________ Phone:_____________________________
Relationship to you? _______________________
Education:
Grade School _______ High School _______ College _______ Special Training _____
For Students - School _________
Occupation
Student______ High School ________ College _____ Other _______
Currently Employed? _____ Name of Employer ________________
Address _____________ Your Position ____
May we inquire of your employer? _________________________
Do you have any relations or friends working here _______ Names: _____________
Experience and Special Skills
Have you worked with elderly people? _________
In what capacity? _________
Have you done volunteer work before? ______ What type? _______________
Where? _________________________________
Have you had any experience in group leadership? ______ Explain Briefly ____________
Do you know any foreign languages? ______ Which ______
Do you play any musical instruments? _________ Which _____________________
Hours of Service
How many hours do you wish to work per week?
Fill in the days and hours you prefer:
Morning
Afternoon
Sunday
_______
________
Monday
_______
________
Tuesday
_______
________
Wednesday
_______
________
Thursday
_______
________
Friday
_______
________
Saturday
_______
_________
Sunday
_______
________
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Evening
_______
_______
_______
_______
_______
_______
______
_______
SAFETY PRECAUTIONS
Elevator Instructions
There are ways in which everyone (residents and staff) can expedite the service and increase safety. When
you wish to use the elevator, push the button only in the direction you want to go. Pushing both buttons
makes the elevator work harder and wastes time.
Repeatedly pressing the button does not hasten the elevator, it wears out the mechanism.
The elevator doors are set to remain open to give you sufficient time to enter or leave without the door
closing. When approaching an elevator and the door is already open, do not rush to get on.
Instead push the “up” or “down” button (depending on the direction you wish to go) outside the elevator
before entering. This will reset the timer so that the door will stay open that much longer.
If you are already in the elevator and see another passenger approaching, please push and hold the “door
open” button until the passenger has entered the elevator.
There are electric eyes (about ankle and hip high) which reopen the door when the beam is broken and
reset the timer to give sufficient time to board.
In addition to the periodic inspection of the elevators, by the city inspector and our authorized elevator
service man, there is another service man who devotes many hours each week to maintain the efficiency
of their elevators.
Fire Procedures:
Volunteers are assigned to a floor will remain on their assigned floor and receive instructions from the
floor captain.
Volunteers on the ground level and first floor will proceed to Lourdes Hall.
Wheelchair Safety:
Make sure nothing is tangled in the wheels. (Seat Belts, Clothes, etc.). Make sure the Resident is sitting
properly with buttocks against the back of the seat.
Push chair slowly and smoothly so Resident feels secure.
Make sure there is enough room to maneuver chair when turning, moving through doors, or moving
around tables etc.
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Carmel Richmond HC & RC
Title: Adult/Junior Volunteer
Supervisor: Director of Volunteers
General Statement of Duties and Responsibilities:
An adult volunteer should provide assistance to the Carmelite Sisters and Carmel
Richmond Nursing Home in the apostolate of the care of the aged and infirm through the
Volunteer Program. Duties assigned are typical of those performed by Adult Volunteers in a
medical or nursing home setting. Specifics vary in accordance with assignment.
Requirements:
All Volunteers Should:
1. Complete an application for Voluntary service, and interview and general orientation with the
Director of Volunteers before assignment.
2. Be flexible regarding duties.
3. Sign in the Volunteer office before duty, and sign out upon completion.
4. Adult females may wear pink Volunteer smocks. All Volunteers must wear name tags for the
purpose of identification while on duty. Smocks may be purchased then kept in the Volunteers
possession and worn for each assignment.
5. Be in the building no more then ten minutes before and after specific assignment.
6. Attend Volunteer orientation and in-service training programs.
7.
Observe fire and general safety rules, parking regulations, and luncheon privleges as outlined by
Administration.
8. Politely refuse to accept any gift, gratuity, payment or bribe for services rendered, or to be
rendered to Residents.
9. Notify the Director of Volunteers of absence or lateness as far in advance as possible.
10. Communicate, if necessary, with other departments through the Director of Volunteers, or
through the head of the department where assigned.
11. Communicate, if necessary, with relatives of Residents through the Unit Manager or Nurse in
charge of the unit. Or through the Director of Volunteers.
I have read and understand the above duties:________________________
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Lifestyles for the Disabled- On Campus
(Speech Pathology students)
300 Howard Avenue
Staten Island NY, 10301
Agency Contact
Please email Yessenia Gonzalez at Yessenia.gonzalez11@my.stjohns.edu to schedule
your service.
Nature and Purpose of Agency
The mission of Lifestyles has always been to provide quality learning experiences that
will enable all program participants, regardless of their disability, to become productive
members of society and live their lives with dignity and as independently as possible. At
Lifestyles, we focus on the abilities of each individual, rather than their disability.
Adapted from http://www.lfdsi.org/programs
Tasks Available for Students
Clients aged 21 and over will come to campus every Wednesday. They will have lunch on
campus, participate in recreational games, and research projects (as directed by Lifestyles).
Time Requirements
Wednesdays from 11:00am - 1:30 pm; no service will be scheduled for February 10th (Ash
Wednesday) and February 24th (spring break).
Agency Directions
Staten Island Campus, DaSilva 110
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