Application Form

Youth wishing to join our Youth Volunteer Program must complete this online application to be added to our wait list. For youth to be eligible for participation in our Youth Program, they must have completed grade 9. If any of your information changes, please contact the Volunteer Services Department at 902-894-2003.

Note: It is never too early to submit your application.

PROFILE INFORMATION

Please complete the application form if you are interested in becoming a youth volunteer at the Queen Elizabeth Hospital.

First name:

Last name:

Title:

Street 1:

City:

Province:

Postal code: *

Home phone:

* OK to call me here

Cell phone:

OK to call me here

Email address:

DEMOGRAPHIC INFORMATION

This information is only used to get a better idea of the demographic makeup of our volunteers.

STUDENTS

Please indicate your expected year of graduation from grade 12 and the school from which you will graduate.

Current Grade:

High School Name:

Expected High School Graduation Year:

HOBBIES AND INTERESTS

List your special skills, hobbies and interests.

WHY DO YOU WISH TO VOLUNTEER?

Please indicate why you are considering volunteering.

EMERGENCY CONTACT

Please provide information for a contact person in case of an emergency.

1

2

First name:

Last name:

Home phone:

Cell phone:

REFERENCES

Please provide contact information for two references not related to you and that have known you for more than 12 months.

1

2

First name:

Last name:

Home phone:

Work phone:

HEALTH

Do you have any health restrictions that might affect you as a volunteer at the hospital?

INFORMATION STORAGE

I consent to having my volunteer information stored on the Volgistics volunteer management system which is external to Health PEI.

I Agree