Volunteer Services Application

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?

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

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

* 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