Junior Application - Greeneville

Please complete this application form if you are interested in Volunteering with us as a Junior Volunteer (ages 14-17 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

First Name:

Last Name:

Middle Name or Initial:

Preferred First Name (if different):

Address 1:

Address 2:

City:

State:

* Zip: *

Home phone:

Cell phone:

Email address:

Parent/Legal Guardian/Emergency Contact

1

2

First Name:

Last Name:

Home phone:

OK to call here

Home phone:

OK to call here

Work phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Cell phone:

OK to call here

Relationship:

Demographic Information

Date of birth:

Criminal Offenses - I have...:

Do you use tobacco/nicotine products?:

Have you volunteered before with Ballad:

Yes

List relatives employed with Ballad Health and location

Availability

Please specify days and times that you would like to Volunteer.

Must be able to serve a minimum of 30 hours.

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.

Are you required to volunteer?:

Yes

List any areas of interest

I AGREE:

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

I Agree

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