Thank you for your interest in becoming an OHSU Healthcare Volunteer. Please complete this application form and when you are done, click the submit button at the bottom.

Under the SSN section, those without US SSN's may enter all "1s" (nine times - example: 111-11-1111) but must include secondary identification information (Visa/Passport)

Oregon Health & Science University values a diverse and culturally competent personnel community. We are proud of our commitment to being an equal opportunity, affirmative action organization that does not discriminate against individuals on the basis of any protected class status. Individuals with diverse backgrounds and those who promote diversity and a culture of inclusion are welcome.

In accordance with Federal Regulations, OHSU does not discriminate based on nationality or country of origin. This information is collected for Export Control regulatory compliance purposes only


*indicates required field


Personal Information


Demographic Information


Availability

Please check all shifts that you are available for and note that each shift is 4 hours in duration. Majority are from 9-1pm and 1-5pm. There are some opportunities for early morning and late evening shifts but are limited and vary in times. Early morning shifts are typically before 9am. Late evening shifts are typically after 5pm.

IMPORTANT: After you submit an application, processing time can take 6-8 weeks so please consider what your availability will be at that time.


Organization/Program Affiliation

Please check the appropriate box if you are affiliated with any of the following organizations or programs listed below.


Emergency Contact

Please list someone we can contact in case of an emergency.


Interest Questionnaire

Please provide a response to the following questions.


Question 1


Question 2


Question 3


Question 4