Our At Your Service Intern Program allows college students that are studying Social Work, Psychology, Nursing, Pre-Medicine, or Hospitality to engage in a non-clinical learning experience at University Hospital. Participants will contribute to the enhancement of the patient and guest experience in a variety of ways. Students will proactively round on patient units to assist with non-clinical needs.


Please complete this application form if you are interested in becoming an At Your Service Intern. Once you complete the form, click the Continue button at the bottom.


Name and address


Demographic Information/ Emergency Contacts

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.



Email Preferences

We like to keep interns 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.



Availability

We would like to know your availability.



Name and Location of School Attending


Academic References

To maintain the quality of our program, please list two academic references



How did you hear about our program?


Why would you like to volunteer at UH?


In what area are you MOST interested In Working?


What previous volunteer experience do you have?


Background

Have you been convicted of a crime or found guilty of disorderly person's offense or misdemeanor (exclude any minor motor vehicle offenses)?



At Your Service Intern Agreement

I understand that the above information provided is correct and true and the information may be used for the purposes under the University Hospital Volunteer Program. I will also conduct myself in a way beneficial to the program and recognize that any violations will result in termination of service.” In order to participate in the At Your Service Program, I understand that it is my responsibility to complete and submit all required forms prior to beginning my assignment.