This application is solely for Texas Health Presbyterian Hospital Dallas. Please complete this application form if you are interested in becoming a SERV Texas Health Presbyterian Hospital of Dallas volunteer. The SERV Program is ONLY for COLLEGE STUDENTS. Volunteers MUST be in the DFW area for 2 whole semesters to be eligible. New applicants will be required to complete 8 hrs/week with a total of 100 volunteer service hours by the end of the semester. Current THD volunteers who have already completed a full semester and 50 hours of service will only be required to volunteer for 4 hours per week. Once you complete the form, click the submit button at the bottom. Please note that if you click on submit and it takes you back to a blank application, the application timed you out and you must resubmit.

Please note, if you are currently employed at any THR entity, you may not also volunteer at that same entity. Please do not apply for Texas Health Dallas volunteering if you are a current THD employee. Applications are accepted for employees of THR from any of the other 13 wholly-owned THR entities and system services.

Demographic Information

First name:

Last name:

Title:

Street 1:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Date of birth:

Gender:

Referral Source:

Marital Status:

I HAVE A VALID SOCIAL SECURITY NUMBER:

Languages:

Projected College Graduation Year:

School:

Major:

Have you been a THR patient?:

Has a family member been a THR patient?:

I am a current employee of THR:

I am not a current employee of THD:

You may contact me via text:

Academic and Extracurricular Experience

Please list your recent extracurricular activites, research, leadership, and academic awards.

Volunteer Experience

Please check this field if you have applied for SERV program.

I am a Previous Applicant:

What volunteer experience do you have?

Career Plans

Please note: if you are a current THD employee, your application will not be considered for volunteering as well as it is against the THR HR policies to be dual status as a volunteer and an employee of the same THR entity. What are your career goals?

Volunteer Essay (minimum of 400 words)

Please use this space to write an essay on why you want to volunteer in SERV and what you hope to learn from being a part of the program.

Background Information

Have you ever been convicted of a felony or misdemeanor? If yes, explain when, where and disposition of the case.

Student Obligations

By checking the box below, I understand I am submitting an application to volunteer as a part of the SERV program and have met/can meet the following requirements:

1. I must be able to commit two consecutive semesters to the SERV program, NO EXCEPTIONS.

2. If I am a new volunteer, I will work two, four-hour shifts weekly for one semester for a total of 100 hours.

3. If I am a current volunteer applying for SERV, I have met my 50 hour requirement to apply for SERV. I will volunteer four hours a week for one semester for a total of 50 hours.

4. I understand that I will be committing to two semesters. The first semester I will be volunteering only. If I complete the hours requirement during the first semester, I will be shadowing during the second semester.

5. I understand shadowing opportunities will be offered almost exclusively during the daytime as dictated by the doctors schedules. Weekend and evening shadowing will most likely not be offered at all.

6. All new volunteers will be required to purchase a uniform (green vest) from the volunteer office for $20.

7. New volunteers will be required to undergo a background check as well as provide at least two references (bring them in if you qualify for round two of the interview process).

I Agree