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:
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Last name:
*
Street 1:
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Street 2:
City:
*
State:
Choose
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
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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:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
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5
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25
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31
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
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1986
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1984
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1982
1981
1980
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1978
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1976
1975
1974
1973
1972
1971
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
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Gender:
Choose
Female
Male
*
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?:
No
Yes
My Availability is:
Sun
Mon
Tue
Wed
Thu
Fri
Sat
Morning (9-1):
Afternoon (1-5):
Evening (5-8):
My availability is:
Choose
Fall (college student/seasonal)
Spring (college student/seasonal)
Summer (college student/seasonal)
Year-Round (traditional)
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:
No
Yes
Education
Are you currently a student?:
Choose
No
Yes
*
What School or University do you attend:
Emergency Contacts
1
2
First name:
*
First name:
*
Last name:
*
Last name:
*
Important Personal Medical Information:
Important Personal Medical Information:
Home phone:
*
Home phone:
*
Cell phone:
Cell phone:
Relationship:
Choose
Aunt
Best Friend
Boss
Boyfriend
Brother
Brother-in-law
Cousin
Co-worker
Daughter
Daughter-In-Law
Domestic Partner
Family Friend
Father
Father and Mother
Father-in-law
Fiancee
Friend
Friend/Roomate
Girlfriend
Godmother
Grandfather
Grandmother
Grandparent
Grandparents
Grandson
Guardian
Husband
Husband/Mother
Lifemate
Mentor
Mother
Mother in Law
Neighbor
Nephew
Niece
Parent
Partner
Pastor
Physician
Roommate
Significant Other
Sister
Sister-In-law
Son
Son and daughter-in-law
Son in Law
Spiritual Leader
Spouse
Step-daughter
Stepfather
Stepmother
Step-son
Supervisor
Teacher
Uncle
Wife
Relationship:
Choose
Aunt
Best Friend
Boss
Boyfriend
Brother
Brother-in-law
Cousin
Co-worker
Daughter
Daughter-In-Law
Domestic Partner
Family Friend
Father
Father and Mother
Father-in-law
Fiancee
Friend
Friend/Roomate
Girlfriend
Godmother
Grandfather
Grandmother
Grandparent
Grandparents
Grandson
Guardian
Husband
Husband/Mother
Lifemate
Mentor
Mother
Mother in Law
Neighbor
Nephew
Niece
Parent
Partner
Pastor
Physician
Roommate
Significant Other
Sister
Sister-In-law
Son
Son and daughter-in-law
Son in Law
Spiritual Leader
Spouse
Step-daughter
Stepfather
Stepmother
Step-son
Supervisor
Teacher
Uncle
Wife
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:
Choose
COLLEGE VOLUNTEER
GUIDE A GUEST
HIGH SCHOOL VOLUNTEER
NON PAID INTERN
TRADITIONAL VOLUNTEER
*
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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