Please complete this application form if you are interested in being a part of our Junior Volunteer program during the summer at Carle BroMenn Medical Center in Bloomington-Normal. Applications are due by Friday May 13 at 12pm.
Once you complete the form, click the Continue button at the bottom.
You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.
State your grade as of the fall semester below.
Please indicate the days and times you are usually available to volunteer.
What special skills or interests do you have that could help impact the hospital experience?
What areas are you interested in giving service?
Do you have any relatives/friends affiliated with the hospital; i.e. family members employed or volunteers at BroMenn. Please explain.
Please include contact information for at least 2 (up to 3) individuals that would be a reference for you.
Please enter your preferred emergency contact below.
What are you hoping to gain from this volunteer experience? (Required)
Were you previously a JV?
If so, when and what department?
If you are returning and it is available, would you like the same department?
Have you ever received notification that you cannot work or volunteer for a healthcare organization that participates in federal or state healthcare programs such as Medicare or Medicaid? Type Yes or No below.