Please complete this application form if you are interested in becoming a Penn State Health Holy Spirit Medical Center volunteer. Once you complete the form, click the Continue button at the bottom. After the application has been submitted, you will be contacted by the Volunteer Coordinator to in regards to a volunteer orientation and interview.

Contact Information

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Demographic Information

Date of birth:

Gender:

Previous Volunteer Experience

Special skills, interests, hobbies, etc.

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Home phone:

Cell phone:

Relationship:

I Agree

I understand and agree that submitting this application form does not automatically register me as a Penn State Health Holy Spirit Medical Center or Penn State Health Hampden Medical Center 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.

I Agree