Volunteer Application Form

Please complete this application form if you are interested in becoming a Northwestern Medicine volunteer. Once you complete the form, click the submit button at the bottom. Someone will contact you within 30 days to discuss opportunities.

Any field with an asterick (*) is a required field.

Name and Address

First name:

Last name:

Middle name:

Nickname:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

* OK to call me here

Cell phone:

OK to call me here

Other phone:

OK to call me here

Email address:

If student, please list the school you currently attend and your scheduled date of graduation.

Other Information

Emergency Contact

Please indicate who we should contact in the event of an emergency.

1

2

First name:

Last name:

Home phone:

* OK to call here

Home phone:

* OK to call here

Work phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Availability

FOR APPLICATION TO BE CONSIDERED, please indicate all days and times you are available to volunteer.

REQUIREMENT

To be considered a 6 month commitment is required.

Reference

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Relationship:

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?

Announcements
Important news regarding upcoming events and new volunteer opportunities

Tagged

Schedule reminders
Reminders of upcoming volunteer assignments

Checklist reminders
Reminders of things we need you to do, usually on an annual basis, to remain an active volunteer at Northwestern Medicine

I Agree

I understand and agree that submitting this application form does not automatically register me as a Northwestern Medicine volunteer, and that there may be certain qualifications I must meet including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree

Return to the Volunteer page