Please complete this application form if you are interested in becoming a UPMC Centers for Rehab Services Volunteer. Once you complete the form, click the Continue button at the bottom.

                                           DO NOT APPLY MORE THAN ONCE


Contact Information


Demographic Information

This information is used only to help us get a better idea of the demographic make-up of our volunteers.



Availability

Do not choose more than TWO locations and indicate the days and time you are available.



Reason for Volunteering


Emergency Contact

In the event of an emergency, whom should we contact?



Citizenship

This information is required:

Are you a U.S. Citizen?  Please indicate Yes or No below.

If you are not a citizen, current Visa and/or Passport documentation are required at your interview appointment.



Message Preference


I Agree

I understand and agree that submitting this application form does not automatically register me as a UPMC Centers for Rehab 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 complete to the best of my knowledge. I understand that any false statement, misrepresentation or omission may cause my dismissal from volunteer service.