Please complete this application form if you are interested in becoming a Western Wisconsin Health volunteer. Once you complete the form, click the Continue button at the bottom.

Name and address

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.


Volunteer Interest

Personal Reference and Emergency Contact

Please list one Personal Reference and one Emergency Contact.

Agreement of Confidentiality

I understand that any information I may obtain directly or indirectly concerning patients, doctors and personnel while I am a Volunteer at Western Wisconsin Health is confidential and that this confidentiality is protected by Federal Law. I am willing to make a six month commitment and will keep in touch with Volunteer Services regularly with any updates.