Please complete this application form (part one) if you are interested in becoming a Mount Sinai SAVI Emergency Department volunteer Advocate. Only completed applications will be accepted - please make sure to answer all questions. Once you complete the form, click the Continue button at the bottom.

Minimum Requirements for consideration of an application:

-Must live in Manhattan, Queens, or Brooklyn (Unfortunately we are not accepting applications from people who reside in the Bronx, Staten Island, or Long Island)

-Must be able to participate in person in a 2.5 hour group interview held on our Upper East Side campus

-Must be at least 21 years of age at the completion of the 40-hour training course

-Must successfully complete the required Mount Sinai Hospital Volunteer Department medical, drug, and background screenings

-Must be available to attend ALL dates/times of the 40-hour training course (there is no make-up time allowed, and any absence/tardiness will preclude completion of the application process). See below for 2019 Dates/Times

-Must be willing and able to commit to a minimum of two six-hour shifts per month, for at least one year.

2019 Training Dates

Tuesday, October 15th, 5:30pm-9:30pm

Saturday, October 19th, 10:00am-5:30pm

Sunday, October 20th, 10:00am-5:30pm

Saturday, October 26th, 10:00am-5:30pm

Sunday, October 27th, 10:00am-5:30pm

Saturday, November 2nd, 10:00am-5:30pm

SPECIAL NOTE: We are accepting applications year-round, however our training beginning in October 2019 is near full, and so we may not be able to accommodate additional applicants. Once our training is filled, any applications received from that point onward will be saved for contact when we begin our recruitment for the next year - July 2020.

Name and address

Demographic Information

Please provide the following information to the best of your ability.


SAVI serves seven different hospital locations, 24 hours a day, 7 days a week. Our volunteer shifts are broken down into six-hour blocks. Please indicate here when you would most likely be available for your shifts.

Emergency Contact

In an Emergency, please notify the following person:


Please note that your reference cannot be a family member or significant other (despite those options being available in the drop down menu).

Background Information

Each volunteer must go through a mandatory background check. Please answer ALL the following questions truthfully.

How did you learn about SAVI?

Why do you want to be an Advocate?

Why do you want to be an Advocate in sexual assault and domestic violence intervention program at this time and what expectations do you have for the Advocate training?

What would you do?

What should someone do to support a person who shares a painful or harmful experience?

Relevant Experience

Please share some personal or professional qualifications or experiences that have prepared you to support survivors of sexual or intimate partner violence in a hospital setting.

Questions, Comments or Concerns

Is there anything else you would like to discuss in your interview? Concerns, questions, comments?

Affidavit on Application for Volunteer Services

I certify that the information contained in this application is correct to the best of my knowledge. I authorize investigation of all matters contained in this application and agree that any misleading or false statements would be cause for rejection of this application or would be sufficient cause for dismissal from a volunteer placement at The Mount Sinai Health System.

I understand that my volunteer placement is contingent upon satisfactory completion of a toxicology screening and a health screening by a Mount Sinai Employee Health service practitioner or private physician, the receipt by Mount Sinai of a satisfactory reference and my satisfactory completion of the probation period. I hereby authorize my present/past employers to furnish Mount Sinai with my records of service.

If I am accepted as a volunteer, I authorize Mount Sinai to conduct any and all verifications as permitted by Federal, State, and Municipal codes and regulations. I agree to abide by all Mount Sinai rules and regulations. I agree to follow Mount Sinai Medical Center policies with respect to a drug-free workplace and I affirm that I do not use unprescribed controlled substances and/or any illegal substances.

I understand that my volunteer service is not governed by any written or oral contract and is considered an "at will" arrangement. This means that I am free, as is Mount Sinai Health System, to terminate the volunteer relationship for any or no reason, as long as there is no violation of applicable Federal, state, or local law.