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 volunteer with us. 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



Agreement

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.