Please complete this application form if you are interested in becoming a Phillips Eye Institute - Early Youth Eyecare volunteer. Once you complete the form, click the submit button at the bottom. Please Note we do require training to be come a Lead Vision Screener. More information to follow.

Name and address

Emergency Contacts

Relevant Volunteer and/or Employment experience

Please list any experience relevant to volunteering for E.Y.E. program.

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.

Background Check

We will have you complete a back ground check during your training orientation.

Languages Spoken?

Please list any other languages you speak.

How did you hear about us?

Posting on Volunteer Board, Friend, Co-worker, School, etc


I understand that submitting this information does not guarantee my acceptance as a volunteer for the E.Y.E. Program. Assignment of volunteer work is based on the assessment made by E.Y.E. Staff.

I understand that continued participation in the E.Y.E. Program is at the discretion of E.Y.E. Staff.

I understand that by completing the attached Request for Background Study form, I give the E.Y.E. Program & Phillips Eye Institute permission to perform all necessary background checks to serve as an E.Y.E. Program volunteer.