Please complete this application form if you are interested in becoming a Scott & White volunteer. Once you complete the form, click the submit button at the bottom.

Contact Information


Demographics

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


Other Volunteer Experience

List other volunteer experiences that you have had.

__________________________________________________


Availability

Please indicate the days and times you are usually available to volunteer.


Assignment Preference


Emergency Contact

In the event of an emergency whom should we notify?


Employer

Please list your current or most recent employer, if applicable.


EMail

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.


References

(PLEASE LIST NAMES AND ADDRESSES)


Criminal History Background Check

I understand that a criminal history background check will be conducted before my volunteer placement begins. I further agree to inform the department if I am named in complaints, indictments, arrests or convicted of offenses.


Volunteer Agreement

I affirm that the information that I have provided is true and correct to the best of my knowledge. I agree to conform with the Scott & White and the Volunteer Services rules and regulations. I also agree to respect the confidential nature of hospital information as well as information obtained as a result of personal contacts with patients. I also agree to participate in orientation and training and understand that I will not be paid for my services as a volunteer. I understand that the volunteer relationship is for an indefinite period and may be terminated at any time for any reason by the Manager of Volunteer Services.


Hobbies/Skills & Talents/Rewards

Please answer the following questions.


I Agree

I understand and agree that submitting this application form does not automatically register me as a Scott & White Volunteer Services volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
By submitting this form, I attest that the information I have provided on the form is true and accurate.