Sinai Together Volunteer Intake Form
Thank you for your interest in helping Sinai Together! You are making a difference.

As a reminder, we are an ad hoc student-run organization that has sprung up to fill a need in the community.

PLEASE READ: If you meet any of the following criteria, we are unable to partner with you at this time and we apologize.

- Experienced a fever in the past 2 weeks
- Experienced shortness of breath in the past 2 weeks
- Traveled to Europe, China, South Korea, Iran, California, etc. in the past 2 weeks
- Had contact with anyone diagnosed with COVID-19
- Have not had a background check as part of your current education program
- Are not fully immunized (standard immunizations + current influenza immunization)

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Email *
Please provide your full name. *
Email address *
Phone number *
Educational Program *
What NY areas are you able to service? (e.g. UES, Morningside Heights, Long Island City, etc.) *
Which services do you feel comfortable providing? *
Required
Would you be comfortable providing childcare in a home with the animals listed below? Please check if comfortable with that type of animal.
Is there a time of day that works better for you? Please check all that apply. *
Required
How many hours per day can you assist? *
Required
How many days per week can you assist? *
Required
Which days of the week are you available? Please check all you are available for, we will keep in mind how many days per week you have noted above. *
Required
If you are interested in helping out with Sinai Together Family Meals. (provide gourmet meals to healthcare professionals) what days are you available to deliver? *
Required
Do you have experience working with children?
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If yes, please elaborate - Not a requirement, but helps us assess capabilities
Do you feel comfortable supervising infants 1-12 months?
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Do you feel comfortable supervising children younger than school age (1 year to 5 years)?
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Do you feel comfortable supervise children school age (6 years to 13 years)?
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How many children would you feel comfortable supervising on your own at one time? Check all that apply.
Do you have experience supervising children with developmental disabilities?
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If yes, please elaborate.
Do you feel comfortable supervising children with well managed chronic health conditions (eg: asthma, type 1 diabetes)?
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PLEASE READ CAREFULLY - Clicking "I agree" constitutes an electronic signature, attesting that you understand and accept the conditions of participation. *
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Required
By checking this box, I am attesting that I have undergone a background check (through a workplace or past/present educational program) and am up-to-date on required vaccinations, including the annual influenza vaccine. *
Required
By checking this box, I understand and agree that I am voluntarily acting in my own individual capacity outside of any affiliation I may have with Mount Sinai. *
Required
Where did you hear about us from?
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