Volunteer Application Form
Please complete this application form if you are interested in becoming a University of Maryland Baltimore Washington Medical Center volunteer. Once you complete the form, click the Continue button at the bottom.
Name and address
First name:
*
Last name:
*
Title:
Choose
Dr.
Mr.
Mrs.
Ms.
Street 1:
Street 2:
Street 3:
City:
State:
Choose
MD
TX
Zip:
Phone #1 phone:
Phone #2 phone:
Email address:
*
Have you volunteered at any hospital in the past? If yes, please name which hospital, your job duties, and the time period you were there.
Limitations
Do you have any physical or emotional limitations we must consider in your volunteer placement? If yes, please explain.
Availability
Please indicate the days and times you are usually available to volunteer.
Sun
Mon
Tue
Wed
Thu
Fri
Sat
From:
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
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8:30am
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9:00am
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9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
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12:00pm
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12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
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2:30pm
2:45pm
3:00pm
3:15pm
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3:45pm
4:00pm
4:15pm
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4:45pm
5:00pm
5:15pm
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6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
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10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
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11:45am
12:00pm
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12:30pm
12:45pm
1:00pm
1:15pm
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2:00pm
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3:00pm
3:15pm
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4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
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12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
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4:15pm
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4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
To:
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
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4:45pm
5:00pm
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5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
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7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
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2:45pm
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3:15pm
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3:45pm
4:00pm
4:15pm
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4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
5:00am
5:15am
5:30am
5:45am
6:00am
6:15am
6:30am
6:45am
7:00am
7:15am
7:30am
7:45am
8:00am
8:15am
8:30am
8:45am
9:00am
9:15am
9:30am
9:45am
10:00am
10:15am
10:30am
10:45am
11:00am
11:15am
11:30am
11:45am
12:00pm
12:15pm
12:30pm
12:45pm
1:00pm
1:15pm
1:30pm
1:45pm
2:00pm
2:15pm
2:30pm
2:45pm
3:00pm
3:15pm
3:30pm
3:45pm
4:00pm
4:15pm
4:30pm
4:45pm
5:00pm
5:15pm
5:30pm
5:45pm
6:00pm
6:15pm
6:30pm
6:45pm
7:00pm
7:15pm
7:30pm
7:45pm
8:00pm
8:15pm
8:30pm
8:45pm
9:00pm
9:15pm
9:30pm
9:45pm
10:00pm
10:15pm
10:30pm
10:45pm
11:00pm
My availability is:
Choose
Ongoing
Ongoing, except between these dates
Only between these dates
From:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
to:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
I would like to serve up to:
hours:
Choose
Daily
Monthly
One time
Weekly
Why do you want to volunteer at the University of Maryland Baltimore Washington Medical Center (UM BWMC)?
References
Please select two personal or professional references and include contact information.
1
2
First name:
*
First name:
*
Last name:
*
Last name:
*
Street 1:
*
Street 1:
*
Street 2:
*
Street 2:
*
City:
*
City:
*
State:
Choose
MD
TX
*
State:
Choose
MD
TX
*
Zip:
*
Zip:
*
Home phone:
*
Home phone:
*
Email address:
Email address:
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
Relationship:
Choose
Co-worker
Daughter
Father
Friend
Mother
Neighbor
Son
Spouse
Supervisor
*
Have you ever been convicted of a criminal offense? If yes, please fully explain.
Emergency Contact
Please provide an emergency contact
First name:
Last name:
Home phone:
Cell phone:
Employer/Business Information
Employer name:
City:
State:
Choose
MD
TX
Describe your participation in other volunteer activities and organizations
Education Information
High school:
Start Date:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2043
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
Language
Please list any languages besides English that you speak fluently
Volunteer Information
Is your interest in our volunteer program in conjunction with a school or court requirement?
Past Volunteering Activities
Have you volunteered at a hospital in the past? If yes, please name which hospital, your job duties, and the time period you were there.
Application Form Agreement
I hereby affirm that my statements and answers to all questions in this application are true and correct, and that I have not knowingly withheld any fact or circumstance which, if disclosed, would affect my application unfavorably.
I Agree
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