Please complete this application form if you are interested in becoming a Baylor Scott & White Health volunteer at one of the following Medical Centers: Austin, Buda, Lakeway, Pflugerville, or Round Rock. Once you complete the form, please click the submit button at the bottom.

Contact Information

First name:

Last name:

Title:

Street 1:

City:

State:

* Zip: *

Cell phone:

Demographics

You may optionally provide gender. It is used only to help us get a better idea of the demographic of our volunteers.

Date of birth:

Gender:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Home phone:

Cell phone:

Education

Education:

Major degree:

School:

Employer

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

Employer name:

Street 1:

Street 2:

City:

State:

Zip:

Work phone:

Location Preference - one location only

Please type the location you'd like to volunteer at using the options below:

Round Rock Medical Center

Lakeway Medical Center

Pflugerville Medical Center

Buda Medical Center

Austin Medical Center

Email

Thank you for providing your email so we can keep you informed of important news, schedules, and volunteer opportunities.

Email address:

What kinds of email would you like to receive?

news, schedules, opportunities

Screening

I understand that a criminal history background check will be conducted before my volunteer placement begins. I have informed the department if I am named in complaints, indictments, arrests or convicted of offenses. I also understand that a TB (tuberculosis) test will be conducted, along with a drug and nicotine screening prior to placement within the volunteer program.

Social security number:

Volunteer Agreement

I agree to comply to the Baylor Scott & White Health Volunteer Services rules and regulations. I also agree to respect the confidential nature of healthcare 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.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree