Care Extender Forms

  • Hours Verification
    • The hours verification request form should be submitted when Care Extenders want to request documentation of their hours or a letter of hours verification (this is not the same as a letter of reference or letter of recommendation).
    • Submit your completed form to the Administrative Coordinator,  at [email protected].
  • Inactivation/Completion Request
    • The inactivation/completion request should be completed through the “Exit Request” link located in the volunteer profile in Samaritan. Please submit the form through Samaritan and hold onto your badge until further instructions. After submission and processing of the form and badge, if eligible, you will receive a completion certificate, letter of reference, and documentation of your hours in the mail. The completion certificate can be requested within one year of completion of the program.

    • For questions on completion eligibility, contact the Administrative Coordinator,  at [email protected].

    • Submit badge to the Care Extender Office in person or by mail to the following address: 1328 16th St. 2nd Floor, Santa Monica, Ca 90404. Do not include badge clip.
  • Leave of Absence
    • A leave of absence request must be submitted two weeks prior to requesting a leave of absence from the program. Care Extenders are allowed one 2-week vacation and one 13-week leave of absence each year in the program. Leave of absence time does not carry over each year. Care Extenders in their first rotation are only allowed to take the 2-week vacation. During the leave of absence period, Care Extenders and prohibited from volunteering in their department.
    • Submit your leave request by logging into the Samaritan volunteer portal and selecting, Request Leave'. If you have any questions, please reach out to the LOA Coordinator [email protected]