Please complete this application form if you are interested in becoming a Goshen Health volunteer. Once you complete the form, click the continue button at the bottom. The information that you provide via this website will be strictly confidential and is intended only for the use of Goshen Health in providing care and services to you.

Name and address


Please list the name of a Goshen Health Colleague or Volunteer who has referred you.


Volunteer Experience

Have you had volunteer experience?


Have you ever been convicted of a Crime?

Hobbies, Interests, Work Experience, Education

Just for us to get to know you better.

Emergency Contact




Please indicate with a check which interests/skills you would be willing to share as a volunteer.


Work Conditions

Policies and Mission

I agree to honor the policies and Mission of Goshen Health and the Department of Volunteer Services. You have my permission to conduct a background check, check all references, and administer a T.B. test and flu shot (The Indiana Board of Health has mandated that all volunteers be tested for tuberculosis, which is paid for by Goshen Health.) The checking of this box will be considered a signature.