Thank you for your interest. Please complete this application form if you are interested in becoming a volunteer. Once you complete the form, click the continue button at the bottom.

Mission of EIRMC

EIRMC's mission statement is:
"Above all else, we are committed to the care and improvement of human life."
How do you think this mission statement may apply to an EIRMC volunteer?

Previous Volunteer Service

Please list your most previous volunteer service experiences.

Date of Birth

Must be at least 14 years of age to be a volunteer.

Date of birth:

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Cell phone:

Email address:

Age range:

Military Service:

What kinds of email would you like to receive?

Electronic newsletters

Every couple of weeks or so a newsletter will be sent out.

Recruitment appeals

Once or twice a year a letter about recruitment efforts goes out.

Text Message

Text is used for short messages, reminders and other basic communication.

Emergency Contact

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Relationship:

How many months can you volunteer?

We require a minimum commitment of 100 hours over the next 12 months to become a volunteer.

High School & College Students Only

Please indicate your anticipated graduation date. Because of the 12 month, 100 hour commitment requirement, this volunteer opportunity is NOT recommended as a Senior Project.
EIRMC wants and needs young volunteers but asks that you realistically evaluate your ability to consistently serve every week. Our patients and staff count on you being here each week.
Can you confidently commit to this obligation?

Which day(s) and times could you volunteer?

Please indicate what day(s) of the week you would typically be available to volunteer. Also indicate what time of the day you can come.
Most volunteer shifts are 3-4 hours.

Desired Activity Level

Very Active (capable of walking 200+ yards at a time, pushing wheelchairs, lifting, and walking stairs)
Moderately Active (walking 100+ yards at a time, light lifting)
Limited Activity (mostly sitting with limited walking)

Hobbies and/or Activities

Please list activities you enjoy doing.

I Agree

I understand I must submit to a reference and criminal background check, as well as an investigation of any and all statements contained in this application, for the purpose of determining volunteer decisions.

I commit to volunteer 3-4 hours each week accumulating to at least 100 hours over the period of at least a year. If I do not meet this commitment, I understand no letter of recommendation will be issued for my service.

In the event of acceptance into the volunteer program, it is my responsibility to read the rules/regulations of EIRMC, position description of my volunteer assignment, and the I AM EIRMC values. I also agree to abide by these rules and regulations and to perform my assigned volunteer duties to the best of my ability. If I cannot perform essential duties and requirements I will notify the Manager of Volunteer Services immediately or request reasonable accommodations in performing essential functions of this position.

Next Steps:

After this application is turned in, an email will be sent to you. This email will contain several forms and an orientation training. Please follow the instructions and complete the forms that will be attached. This process can take up to 4 weeks to complete, please be patient.

If you have questions about any part of this process, please feel free to contact the Volunteer Manager at 208-529-6201.

By submitting this form, I attest that I understand the 100 hour, one year commitment and that the information I have provided on the form is true and accurate.

I Agree