Please complete this request for an application if you are interested in becoming a HMH-JFK Medical Center volunteer. Once you complete the form, click the submit button at the bottom.

Please note: HIGH SCHOOL STUDENTS SHOULD ONLY APPLY DURING THE MONTHS LISTED ON WEBSITE.

Name and address

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

OK to call me here

Work phone:

OK to call me here

Email address:

Demographic Information

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

Date of birth:

Gender:

Education:

Availability

Please indicate the days and times you are usually available to volunteer.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals