SECU Family House at UNC Hospitals » Volunteer Application

Volunteer Application

Contact Information
Full Name*
Birthday*
Address*
Phone Number*
Email Address*
Employment Information
Employer (or most recent if not currently employed)*
Address*
Phone Number*
May we contact you at work?
Yes No
Emergency Contact Information
Name of person to contact
Relationship to you
Phone Number(s)
Please check the area(s) you are interested in:
Fundraising/Development Meal planning/Kitchen Organizing General Office (telephone, mail, etc.) Guest Check-In and Greeting Decorating Wish List Organizing Housekeeping Cooking/Baking Special Events Newsletters Handyman/woman Laundry Computers Gardening Errands Other
Our shifts are 9AM-12PM, 12-3PM, 3-6PM, and 6-9PM.
Please indicate availability or preferred shifts and availability during weekdays, weekends, and holidays. If you have no preference for day or time of day, please note this.*
How freqently you would like to volunteer at the House?*
Previous Volunteer Experience*
Special Skills
How did you hear about SECU Family House at UNC Hospitals?*
Have you or anyone you know had an experience with a hospital hospitality house?
Have you had an experience with someone who is seriously ill or dying?
What are your personal expectations of this volunteer experience?
Have you ever been asked to relinquish a volunteer position (If yes, please explain)?*
Have you ever been charged with and/or convicted of a criminal offense, including but not limited to neglect, child abuse, or assault (If yes, please explain)?*
Please provide three non-family references (indicate Name, Address, Phone Number and Relationship)

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