Volunteer Application Form

Please complete this application if you are interested in becoming a Magee Rehabilitation Hospital - Jefferson Health volunteer. Once you complete the form, click the Continue button at the bottom.

Please note: Our therapy shadowing program is currently on a waitlist. We will be in touch as soon as we are able to bring on new students.

Questions? Contact Shannon Jacobs at Shannon.Jacobs@Jefferson.edu

Name and address

Please complete your personal information. You may optionally provide demographic information that is not required. Demographic information is used only to help us get a better understanding of our volunteers.

First name:

Last name:

Middle name:

Title:

Nickname:

Type:

Kind:

Individual Group

Group name:

Members:

Participation:

If your group will serve more than once, you will usually send...
The same volunteers each time
Different volunteers each time

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Cell phone:

* OK to call me here

Email address:

Web site:

Date of birth:

Age:

Gender:

Education:

School:

Preferred Pronouns:

Availability

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

References

Please share the contact information for three personal or professional references.

1

2

First name:

Last name:

Cell phone:

* OK to call here

Cell phone:

* OK to call here

Email address:

Relationship:

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.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

Emergency Contact

Please let us know who to contact in case of an emergency.

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Why do you want to volunteer at Magee?

Tell us about your prior volunteer experience:

What are your hobbies and interests?

I am passionate about:

I want to learn how to:

I thought you should also know:

Volunteer Onboarding Agreement

Magee Rehabilitation Hospital performs background and OIG checks on all volunteers once a position is determined for the volunteer. This background check reviews criminal and other records, and may disqualify a potential volunteer candidate based on the results of the check. All volunteers must submit a Child Abuse Clearance when they apply. All volunteers also must meet Magee's annual health requirements, including a flu vaccination (October - May). Are you willing to sign an information release form to process a background check, provide your child clearance, and maintain an annual flu vaccination?

I Agree