Utah State Hospital Volunteer Application
Before you attend a Volunteer Orientation, you must have completed a TB test and submitted the results to Volunteer Services at email@example.com
Name and contact information
Note: Please enter your mobile number in the home phone number box if it is the best number to reach you.
If your group will serve more than once, you will usually send...
The same volunteers each time
Different volunteers each time
OK to call me here
18 to 64
65 or over
Volunteering for college credit
If you are volunteering for college credit, please list your school, class name and number of hours required, and INSTRUCTOR'S CONTACT INFORMATION.
Class name and number of hours required:
Is there a language you speak fluently other than English?
American Sign Language
USH Volunteer System Login
Please choose a password to use when logging in to USH's online volunteer system.
Please enter a password that:
Is between 6 and 30 characters long
You must attend orientation prior to volunteering with Utah State Hospital. Please choose the orientation session that you will attend prior to volunteering below. You may click on the link titled "Orientation" for more information. Please only signup for one session of orientation and if you need to change your time, contact Cami Roundy at firstname.lastname@example.org The orientations last 60-90 minutes are held in the Payne Building on Utah State Hospital campus located at 1300 East Center Street in Provo, Utah.
If there are no sessions listed below, please contact Volunteer Services at email@example.com for more information.
I understand that as a volunteer for this State agency, I am considered a State employee for purposes of receiving workers' compensation medical benefits, which shall be the exclusive remedy for all injuries and occupational diseases as provided under Title 34A, Chapter 2, Workers' Compensation Act, and Chapter 3, Utah Occupational Disease Act; the operation of a motor vehicle or equipment if the volunteer is properly licensed and authorized to do so; and liability protection normally afforded a paid governmental employee.
By signing this application I certify that the information I've given is true. I understand that I am bound by a professional code of ethics. I will respect the privacy of patients and will not divulge any patient, staff, or physician information to others.
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