Please select the option(s) that best describe your desired one-time engagement. If you are interested in volunteering more regularly(for more than one time or for more than eight hours ), please go back to the main page to complete the appropriate application.

Contact Information

Please complete the following information about you. If you do not have an email address, please use: INSERT

Emergency Contacts

Please list an emergency contact.


Please indicate the days and times you are usually available to volunteer.

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.

Criminal History

Have you every been convicted of,or plead guilty to a criminal offense(misdemeanor or felony/) UnityPoint Health St.Luke's conducts background checks. Falsification of this or any other information on the application is grounds for immediate termination. A conviction does not necessarily disqualify you from volunteering. Acceptance into UnityPoint Health's volunteer program will be made on a case by case basis

Additional information?

Please provide us with any additional information you feel would help us know more about you.

I Agree

I understand and agree that submnitting this application form does not automatically register me as a Job Shadower or One-Time Volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.
By submitting this form , I attest that the information I have provided on the form is true and accurate. I understand and agree that falsification of this or any other information is grounds for termination.