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Highland-Clarksburg Hospital Volunteer Form
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* Indicates required question
First and Last Name
*
Your answer
Date
*
MM
/
DD
/
YYYY
Address
*
Your answer
Phone Number
*
Your answer
Age
*
18-34
35-50
50+
Required
Highest Level of Education
*
Your answer
Current Employment or Student Status
*
Your answer
Volunteer Experience
*
Your answer
Work/other experience
*
Your answer
How did you learn about our volunteer program?
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HCHI's website
Social Media
Advertisement
Word of mouth
Other:
Special Skills/Hobbies:
*
Your answer
Days available for volunteer work (check all that apply)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Required
Hours available per day
*
Your answer
Time Preferences
*
Your answer
Why do you like to volunteer?
*
Your answer
Areas of interest (check all that apply)
*
Clothing Closet
Dietary
Administration
Marketing/Fundraising
Activities
Required
Please list the name, address, and phone number of 2 references
*
Your answer
Please list any patient or staff member you know at Highland-Clarksburg Hospital
Your answer
Provide your electronic signature below by typing your full name and clicking "Submit"
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