Volunteer Application | WVU Healthcare

Volunteer Status (Required)
Volunteer Status:	Junior Volunteer - 14 - 18, attending high school. Accepted only for Summer. The next enrollment period is April 2014. Student Volunteer - 18+ attending a college/university. Next enrollment period is August 15 - September 9, 2013. Adult Volunteer - 18+ not attending a college/university. Applications accepted anytime.
Name (Required)
First Name:
Middle Name:
Last Name:
Contact Information (Required)
E-mail:
Telephone:	() -Second partThird part
Phone Ext.:
Current Address (Required)
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
Permanent Address
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
Emergency Contact Information (Required)
Name:
Relationship:
Phone:	() -Second partThird part
Felony (Required)
Have you ever been convicted of a crime or are you under charges for any offense against the law other than minor traffic violations?:	Yes No
If yes, give details:
Experience
Prior experience as a volunteer:
How did you become interested in our hospital volunteer program?:
References
References:	Please list two professional references along with complete addresses. Examples: employers, teachers, co-workers, ministers, etc. If you are a Junior Volunteer, you will need to bring two written letters of recommendation to your interview. Letters can be from teachers, coaches, ministers, someone from whom you've babysat, etc. NO RELATIVES PLEASE!
Reference 1 (Required)
Name:
Title:
Phone:	() -Second partThird part
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
E-mail:
Reference 2 (Required)
Name:
Title:
Phone:	() -Second partThird part
Street Address:
Apartment/Address 2:
City:
State:
Zip Code:
E-mail:
Your Service Preferences (Required)
Please select three options. Due to high demand, some positions are not available on a regular basis:	Betty Puskar Breast Care Center (BPBCC) (JSA) Cancer ACS Resource Center (SA) Cheat Lake Physicians (JSA) Chestnut Ridge Day Hospital/ACT Program (SA) Child Development Center (CDC) (SA) (must be 18+) Concierge Volunteer (JSA) Diversional Activity (SA) Emergency Department (ED) (SA) Gift Shop (JSA) Library (JSA) Mail Service (JSA) Medical Center Pharmacy (S) (Available only to Pre-Pharmacy majors. MUST have cash handling experience) Newspaper Delivery (JSA) NICU Cuddler (SA) (must be 18+) Newspaper Delivery – (JSA) Occupational Therapy (OT) (S) (Available only to Pre-OT students.) Office/Resource Volunteer (JSA) Pediatric Ophthalmology Activity Room (JSA) (must be 18+) Physical Therapy (PT) (S) (Available only to Pre-PT students.) Radiology (SA) Rosenbaum Family House (JSA) Surgery Desks (JSA) Surgical Intensive Care Unit (SICU) Waiting Room (JSA) Valet Volunteer (JSA) Wii/Activity Volunteer – 9 East (JSA) WVU Children’s Hospital (SA) (must be 18+) Any available position
Other Service Request:

WVU Healthcare

Guest Services and Other Information

Application For Volunteering