IU Health Volunteer Application

Thank you for your interest in the IU Health Volunteer program for Indianapolis.

Please note: If you are interested in a Volunteer position at Riley Hospital for Children at Indiana University Health or a position in any of the Riley Hospital NICUs located in downtown Indianapolis please go to the Riley Hospital for Children website and complete the Riley Volunteer Application. Riley Hospital does not accept any volunteer applications for persons under the age of 18.

Once you complete the form, click on the (CONTINUE) button at the bottom.

Items marked with asterisk (*) are required.

Name and address

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Work phone:

OK to call me here

Cell phone:

* OK to call me here

Email address:

Demographic Information

Date of birth:

Gender:

Are you a IU Health Employee?

Are you currently employed by Indiana University Health or an affiliate? Please only mark Yes if you are a current IU Health Employee.

* Are you a IU Health Employee?:

Yes

My Availability is:

Criminal Background History:

NOTE: Conviction means you were found guilty by a judge or jury; entered a plea of “no contest;” or plead guilty in court. A conviction may have taken place even if you did not pay a fine or spend any time in jail or prison. A conviction will not automatically disqualify you from volunteer placement. Indiana University Health will determine which convictions disqualify you from a volunteer placement. A misrepresentation may disqualify you from a volunteer position.

Have you ever been convicted of a felony or misdemeanor?

* Criminal Background History:

Yes

Education

Are you currently a student?:

What School or University do you attend:

Emergency Contacts

1

2

First name:

Last name:

Important Personal Medical Information:

Home phone:

Cell phone:

Relationship:

Program Slection

Please let us know which program you are interested in.

COLLEGE STUDENT VOLUNTEER - 50 or more hours served during a 3 to 4 hour weekly shift. This opportunity is open to college students who are 18 years of age or older.

GUIDE A GUEST – 30 or more hours served during a 3 to 4 hour weekly shift. This opportunity is open to all individuals who are 16 years of age or older.

HIGH SCHOOL STUDENT VOLUNTEER - 50 or more hours served during a 3 to 4 hour weekly shifts. This opportunity is open to individuals who are 16 years of age or older.

NON PAID INTERN – This opportunity is open to College students and above, PLEASE PROVIDE REQUIREMENT DETAILS BELOW.

TRADITIONAL VOLUNTEER - 80 or more hours served during a 3 to 4 hour weekly shift. This opportunity is open to individuals who are 18 years of age or older.

Program Slection MH / UH:

Please tell us why you want to volunteer?

Please be as specific as possible and include:

- Characteristics and skills you possess that would benefit IU Health.
- Whether you have worked with patients before and what you found rewarding/challenging about the experience.
- What prior volunteer experience you have.

Is there anything else you want us to know?

PLEASE READ CAREFULLY

I certify that the information in this application (and any accompanying documents) is true. I understand that falsification of any information in this application, discovered before I begin volunteering or while I am a volunteer may lead to my termination.

I hereby authorize Indiana University Health/IU Health Volunteer Services to verify, obtain copies of records and gather any information pertaining to my submitting a volunteer application with IU Health/IU Health Volunteer Services. My signature on this application authorizes IU Health/IU Health Volunteer Services to request written verification as needed.

The receipt of this application does not imply that I will be offered a position as a volunteer. If accepted as a volunteer, I agree to comply with established rules, policies and procedures. This includes, but is not limited to those which relate to confidentiality, employment and universal health precautions.

I understand my volunteer position is at the discretion of IU Health /IU Health Volunteer Services and can be terminated at any time with or without cause, and/or notice.

I Agree

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