Please complete this application form if you are interested in becoming a University of Vermont Health Network-Champlain Valley Physicians Hospital volunteer clergy . Once you complete the form, click the submit button at the bottom. Should you have any questions, please contact the Volunteer Office at (518)562-7595


Name and address


Emergency Contact Information


Parish/Congregation Affiliation

Please list any district/diocese information to assist in verifying your parish/congregation.



Demographic Information


Personal History


Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.



Agreement

If I misrepresent or deliberately leave out a fact in my application, I may be refused volunteer clergy and/or Eucharistic minister status, or have my status revoked. UVM Health Network - CVPH has my authorization to thoroughly investigate my work, medical and personal history. I will hold no person liable for giving or receiving information in this investigation. Any physician, hospital, or testing laboratory may conduct medical tests to determine my ability to perform volunteer duties now or in the future, and may release all information necessary to UVM Health Network - CVPH. I understand that this is not an application for employment, and that granting of volunteer service will not confer an employment status. I agree to confine my activities at UVM Health Network - CVPH within the volunteer program. I may terminate my volunteer status at any time without cause and UVM Health Network - CVPH may terminate or modify the relationship at any time without cause. In consideration of volunteer status, I agree to conform to the rules and regulations of UVM Health Network - CVPH. I have read and agree to the above and certify that the facts I have provided in my volunteer application are true and complete.