Apply to Volunteer at UM Upper Chesapeake Health

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Online Application for Volunteer Services

Volunteer Information

Please check desired location

Age Group:

Availability

First Name

Middle Initial

Last Name

Street Address

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

Date of Birth

Are you currently attending school?

Have you ever been convicted or are you currently being prosecuted for a crime (non traffic)?

Occupation or professional training (current or previous)

Have you ever been employed by UM UCH?

Other skills (not previously addressed)

Previous volunteer experience

How did you learn about our program?

Health Record

Date of last MMR (Measles, Mumps, Rubella) VaccinationMust provide a copy for proof. If you were born after 1957, Please provide a copy of your MMR vaccination or be tested for immunity to MMR (free at the hospital).

Date of last TB Skin Test

Do you have any physical or mental limitations that would affect your placement as a volunteer? If yes, please provide

Person to be notified in case of an emergency

Name

Relationship

Phone

I hereby certify that the answers and explanation to all the preceding questions are true and completed to the best of my knowledge.

Note: A criminal background check is run for every applicant.

Apply to Volunteer at UM Upper Chesapeake Health

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