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High School Volunteer Application Form

Thank you for your interest in volunteering. Please Note: At this time, all college and high school openings are filled. However, please feel free to complete the following information to be stored for future openings.

* Indicates required information
First Name * 
MI * 
Last Name * 
Home or Campus Address * 
City * 
State * 
Zip * 
Birthdate (mm/dd/yy) * 
Last 4 digits of SS # * 
Name of School * 
Graduation Year * 
Phone # * 
Email Address * 
Emergency Contact Name * 
Emergency Contact Phone # * 
Why are you interested in volunteering? * 
What do you hope to gain from your volunteer experience? * 
Why does work in a health care setting appeal to you? * 
What are your career interests * 
List the days and times when you can volunteer Mon.-Sun. * 
Professional Reference Name * 
Professional Reference Phone # * 
Electronic Signature * 
Authentication * 

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I agree to take the training prescribed for volunteers and to follow the guidelines outlined by the Director of Volunteer Services. I agree to report to my volunteer assignment when scheduled. I agree to uphold the purpose and policies of the Department of Volunteer Services and Saint Joseph Regional Medical Center. To the best of my knowledge, the information in this application is accurate and correct.

Saint Joseph Regional Medical Center  |  5215 Holy Cross Parkway, Mishawaka, IN 46545  |  574-335-5000

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