Thank you for your interest in volunteering with the West Valley Hospital in Dallas, Oregon. Please complete this application form if you are over 14 years old and currently enrolled in high school. Once you complete the form, click the "Continue" button at the bottom of the page to submit your application.

( * indicates a required field; if not applicable, please enter "n/a".)


Name and Contact Information

Please provide your name and contact information



Emergency Contact Information

Provide the name and contact information of the person you would want the hospital to contact in case of an emergency situation.



Demographic Information

Your responses provide us with demographic information of our volunteer population.


Please list any languages OTHER THAN English that you speak in the fields marked Language 1 and 2.



Availability

Student volunteers serve for a consecutive 8-month period. Each student serves one day a week, Monday through Friday, for 4 hours per shift.


Please indicate the days and times you are available weekly to volunteer. Students rarely volunteer on weekends or in the evening.



Talents, Skills and Interest

Use the checkboxes below to select the talents, skills, and interests you possess as a volunteer candidate.



Referal Information

How did you hear about volunteer opportunities at West Valley Hospital?



Application Question 1

Your responses to this question and the following questions assist us in determining if you are a good match for our program and help us in finding an appropriate placement for you as a volunteer candidate.



Please use your own words; do not copy and paste your answers from the hospital's website.



Application Question 2


Application Question 3


Application Question 4


Application Question 5


Student Volunteer Agreement

I certify that the information provided in this volunteer application is true, correct, and complete to the best of my knowledge. I understand that continuation of any subsequent volunteer placement depends upon true and accurate representation of the facts stated or implied herein. Additionally, I authorize Salem Health to make inquiries regarding my education, work experience, and references, unless otherwise stated. I hereby release all parties and persons associated with any such inquiries from all claims, liabilities, and damages for whatever reason in connection with information they give.


I acknowledge and agree that I am not obliged if called upon to perform the volunteer services herein applied for, and that West Valley is not obligated to assign or actively seek to assign me to a placement.


I understand this application is not a contract of employment. If I am accepted as a volunteer, I agree to abide by and conform to all policies and procedures of Salem Health and Volunteer Services. I understand that my services are donated to the hospital without contemplation of compensation or future employment, and are given for humanitarian reasons. I understand that volunteering at the hospital does not mean I will get a paid position there in the future.