Thank you for your interest in volunteering at Lynchburg General Hospital. Once you have completed this application form, click the submit button at the bottom.

We do not discriminate based on age, race, ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex, sexual orientation and gender identity or expression.

Contact Information

Please enter your name and contact information. Email is our standard method of communication. Thank you for providing us with a current email address that you will check frequently.

Demographic and Personal

Please provide the following information. It is used only to help us get a better idea of the demographic make up of our volunteers.

Emergency Contact

Please provide Emergency contact information. This should be someone who will be able to make decisions on your behalf if necessary.

Current/Most Recent Employer


Please provide us with two references. These references should not be related to you (non-family):


Please indicate the days and times you are usually available to volunteer.We will attempt to match your availability and interests with the volunteer opportunities currently available. We ask volunteers to make a commitment of at least 1 year.


What are you interested in doing, or willing to do (with training) as a volunteer. Check all that apply:

Skills and Experience

Please tell us more about the skills and experience you have.

Criminal History

Have you ever been convicted of, or pled guilty to a criminal offense (misdemeanor or felony)? (We do criminal checks. Falsification of this or any other information on the application is grounds for immediate termination. A conviction does not necessarily disqualify you from volunteering.)

Anything Else?

Please provide us with any additional information you feel will help us know more about you.

Volunteer Orientation

Orientations are held:

Monday November 21st 10am-12:30pm

Monday December 5th  6pm-8:30pm

Applicant's Certification and Agreement

I certify that the information given by me in the application is true and complete in all respects and understand any falsifications or omissions shall be sufficient cause for dismissal from or refusal of volunteer status.

I authorize my former employers, and persons listed as references on this application to furnish any information concerning my personal character, habits, employment record, and previous volunteer experience. I release all such persons from any liability or damages incurred as a result of responding to our inquiry and furnished this information to us.

I understand and agree that submitting this application does not guarantee that I will be accepted as a volunteer at Lynchburg General Hospital, that there are certain requirements I must meet prior to placement being offered.