Volunteer Services Application

Personal Information

* Last Name

* First Name

Middle Name

* Date of Birth

Citizenship Status Required:

U.S. Citizen

Permanent Resident

Neither

Current Address:

* Street

* City

State

* Zip Code

Telephone Number(s) with area code:

Day

Evening

* Cell

* E-mail address:

Parental Information and Consent

These two forms needs to be downloaded, completed by a legal guardian, and uploaded here before you can submit this application.

Please click here to download the Parental Consent Form for Volunteer Services

* Upload - Parental Consent for Volunteer Services

Please click here to download Background Check Parental Consent Form

* Upload - Background Check Parental Consent

* 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

Volunteer Types

* What language(s) do you speak?

Have you ever volunteered at UHealth?

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 UHealth (if applicable):

Availability

Sunday Morning

Sunday Afternoon

Monday Morning

Monday Afternoon

Tuesday Morning

Tuesday Afternoon

Wednesday Morning

Wednesday Afternoon

Thursday Morning

Thursday Afternoon

Friday Morning

Friday Afternoon

Saturday Morning

Saturday Afternoon

References

* Name

Relationship

* Telephone

* E-mail Address

* Name

Relationship

* Telephone

* E-mail Address

Please complete at least one written reference letter.

Please click here to download the Reference Check form.

* Upload-Reference check

Upload-Reference check (Optional)

Education, Training, and Interest

* Relevant Education - If student, indicate: Academic Affiliation

* Graduation Year

* Relevant training, skills, and experience:

* Why do you choose to volunteer at UHealth?

Signature

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 UHealth.

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Applicant's Signature