Please complete this application form if you are interested in becoming a Lowell General Hospital Volunteer. Once you complete the form, click the submit button at the bottom. Submitting this application form does not automatically register you as a Lowell General Hospital Volunteer.

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Personal Information

Date of birth:

School:

Please provide us with your current employer or school and any notable past work experience or skills.

Employment

Are you a current Lowell General employee? If yes, what department do you work in?

Availability

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

Volunteer Interest

What do you hope to accomplish through your volunteer service at Lowell General Hospital?

Skills and Experience

What do you feel you can contribute to the volunteer program?

Essay

In a few sentences help us get to know you better. How would you describe yourself?

Additional Information

What types of volunteer roles interest you or what would you consider the ideal volunteer role?

Emergency Contact

First name:

Last name:

Home phone:

Cell phone:

Email address:

Relationship:

I Agree

I understand and agree that submitting this application form does not automatically register me as a Lowell General Hospital volunteer.

I Agree