Thank you for your interest in volunteering at Centerpoint!

Please complete and submit this application to Willa Lincoln, Volunteer & Pastoral Care Coordinator. Once the application is received there will be an interview to determine if there are current openings in areas which appear to match your interests and availability. If accepted to volunteer service, applicants are required to: (1) complete a lab screening for tuberculosis and titers: paid for by the hospital, (2) have a background check: paid for by the hospital, and (3) complete 1 day of hospital orientation. All volunteers are asked for at least a 4 hour a week volunteering commitment.

Required fields are marked with an asterisk *.

Applicant information

In case of emergency, please notify:

Education and experience

Previous volunteer experience:

References

Available time for volunteering (please check all time that apply)

Applicant acknowledgment: I certify that the information given by me in this application is true

and complete. I hereby authorize all individuals and organizations named or referred to in this

application to give Centerpoint Medical Center all information relative to my possible volunteer

assignment and work habits. I hereby release such individuals, organizations and Centerpoint

Medical Center from any liability for any claim, damage, which may result. I understand that I

will not be paid for time volunteering at Centerpoint.

Success

The form was successfully sent.

There was an error with the form submission.