NYP Queens Volunteer Application

Personal Information

Application date

* First name

* Family/last name

* Address

Apt#

* City

* State

* Zip/postal

* Cell Phone No.

* Home Telephone No.

Work Telephone No.

* E-mail address

Emergency Contact Information

* Emergency Contact Person

* Relationship

* Home Telephone No.

* Cell Phone No.

Work Telephone No.

Demographic information

***You must be a minimum of 16 years of age or older in order to apply***

Are you 16 or 17 years of age?

Are you 18 years of age or older?

Current School/Institution enter N/A if not in school

School Address

Current grade

Highest Level of Education

Major/Concentration

Are you required to volunteer for school? if so, what is the teachers name and email address?

Required for school

Teacher name:

Teacher email:

Character Reference

Parents and other Famliy members will not be accepted as a Character Reference

* Name of Character Reference

* E-mail address

* Phone Number

Relationship to Applicant

* Name of Organization

*PARENTS /FAMILY MEMBERS ARE NOT ACCEPTABLE CHARACTER REFERENCES

Availability

Monday

8am - 12pm

12pm - 4pm

4pm - 8pm

Tuesday

8am - 12pm

12pm - 4pm

4pm - 8pm

Wednesday

8am - 12pm

12pm - 4pm

4pm - 8pm

Thursday

8am - 12pm

12pm - 4pm

4pm - 8pm

Friday

8am - 12pm

12pm - 4pm

4pm - 8pm

Bi-lingual Skills

Please indicate other languages in which you are fluent

Additional languages

Employment

* Are you currently working? If so, please indicate current place of employment and your schedule.

About You - Question 1

* Why would you like to volunteer at New York- Presbyterian Queens?

About You - Question 2

* List and explain any volunteer experience you've had in a hospital or other settings.

About You - Question 3

* What do you hope to gain by participating in this program?

I can committ to 10 months or more to NYP Queens Volunteer Services

Who referred you to us? (Full name please)

Referrer: Phone

Referrer: Email

Your connection to this person:

How did you hear about our program?

If Online, please explain:

Agreement

I understand and agree that submitting this application form does not automatically register me as a New York- Presbyterian Queens Volunteer.

I am aware there may be certain qualifications I must meet, including orientation, medical clearance, background check and a 10 month commitment.

By submitting this form, I attest that the information I have provided on this form is true, accurate, and NOT provided by a third party.

I Agree

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Signature

NYP Queens Volunteer Application

Volunteer Application Form

Your application will not be considered if any of the sections are left left blank.