Volunteer Services

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UMMC Volunteer Application Form

* - Required Fields

First Name* 
Middle Initial
Last Name* 
Maiden Name
Preferred Name
Date of Birth* (must be at least 16 years old)  
Sex*
Social Security #*--   
Address* 
City, State, Zip Code*  -  
Email* 
Home Phone*() -    
Mobile Phone() - ext.
Emergency Contact(s)
Relationship to Volunteer* 
Last Name* 
First Name* 
Street Address* 
City, State, Zip Code*  -  
Home Phone*() -    
Mobile Phone() - ext.
References (No relatives)
Name* 
Email* 
Name* 
Email* 
Volunteer Assignment Preferred*
Days and Hours Available* 
Click to read the The UMMC Information Systems Security Acknowledgement and Nondisclosure Agreement.* 

As a volunteer of UMMC, I agree to the above reference checks, TB skin tests, a background check, and a minimum of 3 months of volunteer service.

Volunteer Signature* 
Parent or Guardian signature for volunteers under 18. If you are under 18, a parent must be present for your fingerprinting and TB skin tests.
After submitting the application form, please read and sign the Volunteer Agreement (link located in the menu to the left).