Junior Volunteer Application

Please complete this application form if you are interested in becoming a UnityPoint Health - St. Luke's Sioux City Junior Volunteer. You must be at least 13 years old or in the 7th grade to be eligible. Once you complete the form, click the submit button at the bottom.

Contact Information

Provide complete contact information. You must provide an email address other than your school email.

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

* Zip: *

Home phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Languages:

Demographics

Please provide the required information in this section. All other information is optional. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Age:

Age range:

Gender:

T-Shirt size:

Junior High School:

High school:

References

Please include two references such as a teacher, pastor, counselor, or employer.

1

2

First name:

Last name:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Work phone:

* OK to call here

Work phone:

* OK to call here

Email address:

Please list your relationship to both references here

Reason for Volunteering

Please explain your interest in volunteering

Emergency Contacts

1

2

First name:

Last name:

Title:

Street 1:

Street 2:

Street 3:

City:

State:

Zip:

Home phone:

Work phone:

Cell phone:

Relationship: