Yale New Haven Hospital

High School Volunteer Application

Thank you for your interest in volunteering at Yale New Haven Health System.

Before completing an application, please be sure to read the requirements on the Yale New Haven Health System volunteer website.

1. Students must be 15 years of age.

2. Criminal Background Check: Required for volunteers 18 years old or older.

3. Training Requirement: Initial Orientation and Assignment Specific Training provided.

4. Medical Requirements: Must be cleared by YNHHS Occupational Health Department.

5. Commitment Requirement.

Please complete all required fields below to establish your applicant profile and apply for a volunteer position.

Please create your user name and secure password.

Secure passwords should contain a minimum of 5 characters with at least one number, one uppercase letter and one lowercase letter.

Volunteers are responsible for the safe keeping of their passwords.

PLEASE DO NOT SHARE your password with anyone.

Please contact HighSchoolProgram@ynhh.org if you experience any issues completing this form. Please reach out if you do not receive an email communication within approximately7 days of submitting your application.

* User ID/e-mail address

* User ID/e-mail address confirm

* Password

* Password confirm

High School Students, please choose the session you are applying for. Check all that apply.

* Today's date

* First name

MI

* Last name

Gender

* Date of Birth

* Street Address

* City

State

* Zip/postal

* E-mail

Please enter your preferred phone number.

* Mobile Phone

Home Phone

* Name of High School

* High School Graduation Year

Emergency Contact Information

* Name

* Relationship to you

Street Address

City

State

Zip/postal

* Mobile Phone

Home Phone

Work Phone

* Emergency E-mail

Additional Volunteer and Community Activities

Agency/Organization

Position

Dates (to and from)

Agency/Organization

Position

Dates (to and from)

Agency/Organization

Position

Dates (to and from)

Have you ever volunteered at Yale New Haven Health System? If so, when and at which hospital?

If referred by a friend/family member/volunteer, please provide name below.

More About You

* REFLECTION: Please share your reflection in the box below. Topics can include but are not limited to: future career goal,a personal story, aspirations, reasons for wanting to volunteer, special skills and interests, etc. (Limit 1200 characters)

* How would you describe your ideal volunteer experience? (Limit 800 characters)

* What are some of your strengths and weaknesses,skills and talents? (Limit 400 characters)

Other language(s) you speak fluently:

For students under 18, parent/guardian signature is required. I hereby agree to volunteer without pay at Yale New Haven Hospital. I certify that the information that is provided on this application is complete and true. I further acknowledge that falsification or omission of any significant information presented or requested on this application or during the interview process may result in rejection or dismissal from a volunteer position.

Applicant Signature:

*

I give permission for _______________________ to volunteer at Yale New Haven Hospital, and to be photographed in relation to his/her volunteer position. These photos may be used in marketing materials (Volunteer Voice newsletter, brochures, press releases to recruit volunteers, etc.).

Parent/Guardian Signature:

For students 18 years or older, a criminal background check will be conducted. For the safety of patients, their families, and hospital staff, the screening process for Yale New Haven Hospital volunteer applicants over age 18 includes a comprehensive background check, to be conducted with your signed authorization upon receipt of your application.

Applicant's Signature: