Please complete this application form if you are interested in becoming a Capital Health Adult Volunteer. Once you complete the form, click the submit button at the bottom.

Personal Information

Demographic Information

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.

Applicant Questions

What is the reason you'd like to volunteer and what do you envision yourself doing if selected for the program?

Volunteer History


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

Special Skills & Qualifications

Summarize special skills and qualifications acquired from employment, volunteer work, or other experience, such as hobbies, sports, etc.

Criminal History

Have you ever been convicted of, or pled guilty to a criminal offense (misdemeanor or felony)? (We do criminal checks. Falsification of this or any other information on the application is grounds for immediate termination. A conviction does not necessarily disqualify you from volunteering.)


Please list 2 non-family references

Emergency Contact

Please list one emergency contact

I Agree to the following terms:

All applicants are considered for available positions for which they are qualified without regard to race, color, religion, sex, national origin, age, disability, or veteran status.

My confirmation below affirms that all the facts set forth in my application for are accurate and complete.