Please complete this application form if you are interested in becoming a volunteer at USA Health. Once you complete the form, click the submit button at the bottom.
Please list your full legal name. If you go by a nickname or a name other than your first name, please list it in the preferred name section.
This information is used only to help us get a better idea of the demographic make-up of our volunteers. Please list the graduation year or anticipated graduation year if applicable.
Please Indicate the days and times you are usually available to volunteer and which assignment site you prefer. Note: Volunteer assignments are for 3-4 hours once a week, with a commitment of at least 6 months. Some sites are dependent on space and availability.
Please list your current or most recent employer. If you are a USA Student Worker, please indicate this on the Job Title line. If you have not been employed, please list any volunteer experience.
Application deadline: January 27, 2023
Orientation dates: Tuesday, January 31 or Thursday, February 2
Orientation time: 1:30p-3:30p
Session Dates: February 20, 2023- August 20, 2023
Application deadline: April 30, 2023
Orientation dates: Tuesday, May 2 or Thursday, May 4
Orientation Time: 1:30p-3:30p
Session Dates: May 30, 2023- November 30, 2023
Session 3B: This session is designated for college students who are home for the summer. This does not apply to students who attend college locally. Volunteers for this session are excepted to commit to 8 hours a week. ( Two 4 hour shifts a week)
Session Dates: May 30, 2023- August 4, 2023
Application deadline: August 25, 2023
Orientation dates: Tuesday, August 29 or Thursday, August 31
Session Dates: September 18, 2023- March 18, 2023. Start date could be sooner then date listed.
In the event of an emergency, whom should we notify?
Please list 2 professional references (e.g., teacher, employer, etc.). Please do not list personal references such as friends or family members.
If you have any relatives who are employed through the University of South Alabama, please list their name and the department in which they work.
All volunteer applicants must email proof of the following to email@example.com PRIOR to submitting application.
1. Immunizations against MMR (measles, mumps, rubella)Two doses required.(If born before 1957 no documentation of MMR is required. If born after 1957, a self-reported 1st MMR is acceptable with a documented 2nd MMR booster).
2. Varicella vaccine (chicken pox) *TWO doses required or history of chicken pox.
3. Tuberculosis skin test: Volunteer applicants must provide written documentation of a negative test within the previous 12 months. Acceptable TB screening methods: interferon-gamma release assay (ICRA)(e.g., T-Spot, Quantiferon [QFT]), tuberculin skin test (TST).
Applicants without documentation of a negative test result during the preceding 12 months, will need to provide documentation of a 2-step Tuberculin Skin Test (TST):
1. initial TST (read at 48-72 hours), if negative;
2. a second TST (read at 48-72 hours) to confirm the first reading given 1-3 weeks from the first test
Applicants with history of Positive TB Screening Test requires documentation confirming a previous positive tuberculin skin test and documentation of a normal chest x-ray after a positive TB skin test.
4. One-time adult dose of Tdap vaccine. Within the last 10 years.
5. A flu shot is mandatory.
6. Covid vaccine (fully vaccinated). This includes Johnson & Johnson single dose vaccine, 2 does of Moderna or Phfizer vaccine. Booster is not required but if you have it you can submit it the documentation.
Please list any medications, food, chemicals or products to which you are allergic. Also list any chronic medical conditions you may have (e.g., high blood pressure, diabetes, etc.) as well as medications you are currently taking.
Have you ever been convicted of a felony or misdemeanor (including pleading guilty and nolo contendere)? Falsification of this or any other information on the application is grounds for immediate dismissal. All volunteer applicants must agree to undergo a background screening paid for by USA Health's University Hospital.
Why do you want to volunteer at USA Health?
How did you learn about the volunteer program at USA Health?