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

Volunteer Services Application

Application Type
Last Name
First Name
Middle Name
Birth Date
Age
0
Status
  • - Select a Status -
  • Single
  • Married
  • Divorced
  • Widowed/Widower
Address
City
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
Zip Code
Home Phone
Mobile Phone
Contact Email
Re-Enter Email
Emergency Contact
Emergency Phone
Relationship
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
Work Status
Employer
Occupation
Hobbies, Skills, Interests

Volunteer Experience

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

Teen / College Student

School Name
Grade
Graduation Year
College Major
Are you planning a medical career?
  • - Select an Option -
  • Yes
  • No
Are you required to volunteer?
  • - Select an Option -
  • Yes
  • No
How many hours?

Your signature indicates approval for us to check all references

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

Medical References

Family Doctor
Address
Phone
Health Limitations

Personal References

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

Volunteer Availability

Please check all that apply.
Morning
Afternoon
Evening