2025 Student Healthcare Opportunity Program for Volunteers

2025 Student Healthcare Opportunity Program for Volunteers

(Age requirement: 16 years or older)
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
[email protected]
Name of School*
Grade/Fall 2025*
Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Please list the day(s) of the week that you are interested in volunteering.*

MondayTuesdayWednesdayThursdayFridaySaturday
MONDAY: Please list the times (beginning/end) that you are interested in volunteering. *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
TUESDAY: Please list the times (beginning/end) that you are interested in volunteering. *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
WEDNESDAY: Please list the times (beginning/end) that you are interested in volunteering. *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
THURSDAY: Please list the times (beginning/end) that you are interested in volunteering. *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
FRIDAY: Please list the times (beginning/end) that you are interested in volunteering. *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
SATURDAY: Please list the times (beginning/end) that you are interested in volunteering. *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Please be sure to take all of the following into consideration when choosing your dates. Vacations, driver’s ed, summer school classes, sports, employment times, doctor appointments, etc. When choosing please keep in mind that you need to complete six weeks of the seven-week program.
Please list some areas within the hospital that you are interested in volunteering.
Area 1*
Area 2*
Area 3*
Personal References

(List a current teacher and non-family members)
Reference 1 Name*

First NameLast Name
Reference 1 Relationship*
Reference 1 Phone Number*
Please enter a valid phone number.
Reference 2 Name*

First NameLast Name
Reference 2 Relationship*
Reference 2 Phone Number*
Please enter a valid phone number.
Reference 3 Name*

First NameLast Name
Reference 3 Relationship*
Reference 3 Phone Number*
Please enter a valid phone number.
T-Shirt Size*

SmallMediumLargeX-Large2XL3XL4XL
Mandatory Orientation Date*

Tuesday, June 10th 10:00 – 11:00 a.m.Tuesday, June 10th 1:00 – 2:00 p.m.
Should be Empty:

	
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2025 Student Healthcare Opportunity Program for Volunteers

Personal References