Please complete the following Volunteer Services Application online and submit. After submission, you will be contacted to set up a personal interview.

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Volunteer Services Application

Application Type
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Last Name
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First Name
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Middle Name
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Birth Date
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Age
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Status
  • - Select a Status -
  • Single
  • Married
  • Divorced
  • Widowed/Widower
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Birth Date
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Age
0
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Status
  • - Select a Status -
  • Single
  • Married
  • Divorced
  • Widowed/Widower
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Address
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City
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State
  • - Select One -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Field is required!
Zip Code
Valid Zip Code is required!
Home Phone
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Mobile Phone
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Contact Email
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Re-Enter Email
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Emergency Contact
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Emergency Phone
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Relationship
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Optional
We encourage you to voluntarily provide the following, on racial background and ethnicity.
  • - Select an Ethnicity -
  • Am Indian/Alaskan Native
  • Asian
  • African American
  • Caucasian
  • Hawaiian/Pacific Islander
  • Hispanic/Latino
  • Not Hispanic/ Latino
  • Other
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Work Status
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Employer
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Occupation
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Hobbies, Skills, Interests
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Volunteer Experience

Please include where and what you did. Click the Plus + for additional entries
Volunteer Location
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What did you do?
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Have you ever been convicted of a felony?
A past conviction does not necessarily prevent you from being considered.
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Please describe
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Teen / College Student

School Name
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Grade
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Graduation Year
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College Major
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Are you planning a medical career?
  • - Select an Option -
  • Yes
  • No
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Are you required to volunteer?
  • - Select an Option -
  • Yes
  • No
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How many hours?
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Your signature indicates approval for us to check all references

Volunteer Signature OR Signature Name of Volunteer’s Legal Guardian (if applicable)
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Medical References

Family Doctor
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Address
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Phone
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Health Limitations
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Personal References

Please list non family, such a minister, teacher, guidance counselor, or neighbor whom we may contact.
Name
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Title
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Phone
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Name
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Title
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Phone
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Do you know any WHS Employee?
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Name
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Volunteer Availability

Please check all that apply.
Morning
Field is required!
Afternoon
Field is required!
Evening
Field is required!