Please complete this application form if you are interested in Volunteering with us as a Junior Volunteer (ages 14-18 not in college). Once you complete the form, click the submit button at the bottom. You will receive an automated email with further details. If you do not supply an email address on your application, we will contact you by phone in approximately 2-3 weeks to confirm your acceptance and let you know the next steps.


Name and Address

Parent/Legal Guardian/Emergency Contact

Demographic Information

Is this application for a HOSA program?

Describe Your Interests and Goals

We will consider this information when assigning your placement if at all possible. Please note that all areas mentioned may not be available.


That all information provided is true and accurate to the best of my knowledge. If accepted into the Junior Program, I agree to complete all additional requirements and follow all guidelines set forth.