Thank you for your interest in the Weekday Volunteer Program at Ann & Robert H. Lurie Children's Hospital of Chicago! We are always seeking qualified candidates to volunteer with our patients and families.

Before proceeding to the questionnaire, please confirm that you are able to answer yes to the following:

I have a set schedule, and I am able to make (at least) a six-month commitment to a weekly volunteer shift.
- Shifts are approximately three hours, and occur sometime M-F, between 9am-5pm, at the same day/time every week.
I am NOT a high school, college, or graduate student and will not become one in the coming 6 months.
- If you are, please go back and complete the College Volunteer Program Application.
I am able and willing to receive the COVID-19 vaccine, as it is mandatory for all volunteers.
I am 18 years of age or older.

Please keep in mind that this questionnaire is used as a preliminary screening tool. Please allow some time to consider and answer the questions.

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Permanent Address (if different):

Date of birth:

Demographic Information

We collect this information for statistical purposes only, in order to assess and improve our efforts to attract and retain a diverse volunteer base that reflects the diversity of the patients and families we serve. Answering the following questions is strictly voluntary, and your answers or decision not to answer will not affect your eligibility for volunteering in any way.

Race:

Gender Identity:

Language Skills

Commitment

The weekday program requires a weekly commitment to a three hour shift. This shift would occur sometime M-F, between 9am-5pm for at least six consecutive months. Volunteer shifts are set, which means that volunteer always come in on the same day of the week during the same shift time for the full, 6-month commitment.

We ask for a consistent long-term commitment in order to provide the best possible care for our patients and families. Are you able to make a commitment of this nature at this time? Please consider this question carefully.

Hospital Environment- Part 1

Please list any current or previous experience you have in a healthcare setting, as well as how long you did it. (For example: previous volunteering, interning, working, etc.)

Hospital Environment - Part 2

The families whose children are being treated at our hospital are often under great stress. We seek volunteers who are comfortable extending friendly, calm and appropriate support to ease their stress. Are you comfortable working with a diverse patient/family population? Please describe a time when you were able to extend friendly, calm, and appropriate support to a young person or family who was struggling.

Hospital Environment - Part 3

Volunteer assignments involve direct work with patients and families. We seek people who are very comfortable working with children of a variety of ages, abilities, and illness levels. This may also include children experiencing trauma and/or other mental health crises or who may have behavior challenges. Please let us know about relevant experience you have working or interacting with children/youth.

Hospital Environment - Part 4

What personal characteristics do you possess that you believe will assist you with volunteering at Ann & Robert H. Lurie Children's Hospital of Chicago? And how do you see yourself contributing to the hospital experience as a volunteer?

Emergency Contact

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

I Agree

I understand and agree that submitting this questionnaire does NOT automatically register me as a Lurie Children's volunteer.

My application will be reviewed, and I will be contacted about next steps, should my background and experience match the hospital's current volunteer needs.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I understand that if I am accepted as a volunteer:

I voluntarily offer my services with a clear understanding there will be no monetary compensation.
I agree to conform to all Lurie Children’s rules and regulations and those specific to Volunteer Resources as outlined in the Volunteer Orientation Manual.
I will need to satisfy the Lurie Children’s Health Service requirement for volunteers prior to beginning service.
I will need to satisfy the Lurie Children’s criminal background check prior to beginning service.
Any false statements made as a part of this application will be considered cause for dismissal.
I also grant permission for Lurie Children’s to investigate references regarding past employers and volunteer organizations. I release said organization(s) from any and all liability resulting from such investigation.

By checking the below box labeled "I agree" you are applying your signature and you agree to the above statements. This electronic form will be retained in your volunteer file.

I Agree