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UMMC Volunteer Application Form
Must be 16 years of age or older to apply.
Please allow two weeks for application processing.
*
- Required Fields
First Name
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Middle Initial
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*
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Address
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City, State, Zip Code
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Email
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ext.
Emergency Contact(s)
Relationship to Volunteer
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Last Name
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First Name
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Street Address
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City, State, Zip Code
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AL
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AZ
CA
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DE
FL
GA
HI
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ID
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KS
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MD
ME
MI
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MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
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Home Phone
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Mobile Phone
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ext.
References (No relatives)
Name
*
Email
*
Phone Number
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Name
*
Email
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Phone Number
*
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)
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Volunteer Assignment Preferred
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Children's Hospital
Adult Hospital
Spiritual Care
Days and Hours Available
*
Click to read the
The UMMC Information Systems Security Acknowledgement and Nondisclosure Agreement.
*
I have read the Information Systems Security Acknowledgement and Nondisclosure Agreement.
As a volunteer of UMMC, I agree to the above reference checks, TB skin tests and a background check.
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).