Please complete this application form if you are interested in becoming a University Hospitals Samaritan Medical Center volunteer. Once you complete the form, click the Continue button at the bottom.

Contact Information

Skills & Experience

Please describe any relevant skills or experience.


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

Assignment Preference

The following volunteer assignments may currently be available. You may click the assignment names to learn more about that assignment. Use this list to rank your top three assignment choices.


Please list your current or most recent employer, if applicable.


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.

Volunteer Information Center

We provide an online "Volunteer Information Center" where volunteers may check their schedules, update their information, and receive messages. Please select the password you would like to use to access the online Volunteer Information Center.

Service Requirement

Active volunteers complete a minimum of 30 volunteer service hours per calendar year. How many hours are you able to volunteer per month?

I Agree

Please read carefully and acknowledge below:

Qualified applicants are considered for all volunteer positions without regard to race, color, religion, sex, national origin, age, disability or veteran status.

I understand that I will be expected to abide by all volunteer policies. I also understand that I must be committed to serve a minimum of 30 hours annually as an active volunteer.

I understand the application, interview, background investigation, and placement process are required of all volunteer applicants and are in no way a contract of volunteer service or promise of future volunteer opportunities. I understand I will be required to attend a volunteer orientation.

I certify that the above information I have given on this application is true and complete. I authorize investigation of all statements contained in this application and understand that my giving false information is sufficient for my discharge, if accepted. Due to the nature of some volunteer positions, I authorize the companies, schools or persons named in this application to provide information regarding me and hereby release them from liability for issuing this information.

I understand that I will be required to submit to a criminal background investigation. If I fail to complete the necessary background investigation authorizations, I will no longer be considered for volunteer service. Consideration for volunteer service is also contingent upon a background investigation that does not reveal any disqualifying offense(s).

UH Samaritan Medical Center is not obligated to offer a volunteer assignment, nor am I obligated to accept a volunteer assignment offered.

I understand and agree that submitting this application form does not automatically register me as a University Hospitals Samaritan Medical Center volunteer.

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