Please complete this application form if you are interested in becoming a Henry J Austin Health Center volunteer. Once you complete the form, click the Submit button at the bottom.


Name and address


Demographic Information

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



Gender Identity and Pronouns

Henry J Austin Health Center is an inclusive space for everyone no matter their identity, status, or background. If you wish, please input your gender identity and pronouns you use. 



Availability

Please indicate the days and times you are usually available to volunteer.  You can also describe any additional information surrounding your availability. 



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.



Emergency Contact Information

In the event of an emergency who would be best for us to contact?



Volunteer Interest

We have a need for volunteers in the following areas:

  • Reading Buddy (reading to children in the pediatric waiting area)
  • GivingTuesday (volunteers to table in the community or during our art gallery)
  • Thanksgiving Food Pantry Pop-Up (handing out food to community members during our pop-up pantry)
  • General (If you would like to be notified about new volunteer opportunities as they come)

Please indicate if you have a preference for one of these opportunities, wish to be notified of new opportunities, or want to speak with the Volunteer Program Coordinator about volunteering in a way not listed. 



Volunteer Agreement

The goal of the volunteer program is to support the Vision and Mission of Henry J. Austin Health Center while upholding our values and giving volunteers a meaningful experience as they volunteer and work alongside staff. This cannot be achieved without a strong sense of commitment from the volunteers that we bring on. To achieve the best experience for volunteers, staff, and of course our patients, there are a few rules and expectations we have of volunteers when they come into the center and begin working alongside us:

  • Abide by all rules and policies in the Volunteer Handbook and set by Henry J Austin Health Center.

  • Hold in confidence and respect the privacy of the people and patients that are served within the center. 

  • Maintain the patient's welfare as a primary concern when representing the center during my volunteer shifts. 

  • If issues or concerns of safety, boundaries, rules, etc. occur I will inform and discuss this with the volunteer coordinator.

  • Attend all scheduled volunteer shifts or alert the volunteer coordinator of the absence promptly. 


By checking below you have read the Volunteer Handbook and understand the rules and expectations of you as a volunteer and agree to abide by them while serving as a volunteer with Henry J Austin Health Center.