Volunteer Services Application (High School Student)

Personal Information

* Last Name

* First Name

Middle Name

* Date of Birth

Citizenship Status:

Do you have an F1 Visa?

Current Address:

* Street

* City

State

* Zip Code

Telephone Number(s) with area code:

Day

Evening

* Cell

* E-mail address:

Parental Information

* Parent/Guardian Name (First and Last)

* Parent/Guardian E-mail

* Parent/Guardian Cell

Emergency Contacts

* Name:

* Relationship to you:

Telephone Number:

* Cellular Number:

Physician's Name:

Hospital Affiliation:

Physician's Telephone Number:

Volunteer Service Information

Are you a current University of Miami (UM) student?

What language(s) do you speak?

Have you ever volunteered at the University of Miami?

If yes, please indicate:

Start Date

End Date

* Volunteer Position

* UHealth Department

Location

Contact / Supervisor

Name(s) and Department(s) of family members employed at the University of Miami (if applicable):

Education, Training, and Interest

Education: High School Attending

Graduation Year

Relevant training, skills, and experience:

Why do you choose to volunteer at the University of Miami?

References

Please provide a professional or academic reference below. References from friends or family members will not be accepted.

* Name

* Relationship

* Telephone

* E-mail Address

Signatures

I certify that all statements in this application are true. I also agree that if I am accepted as a volunteer, I will abide by all regulations of the University of Miami.

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Applicant's Signature: