College Student Application

I am over the age of 18. I am NOT a High School student
Personal
Application date
Family/last name
First name
Street Address
City
State
Zip/postal
Home phone
Mobile
E-mail
Do you speak any additional languages?
Contact Information
Present School
Highest grade
Name of your emergency contact
Home phone
Mobile
Current / Most Recent Employer
Supervisor Name
Business Phone
How did you hear about our program?
I understand that I must be available to meet the minimum requirement of 3 hours per week for a period of 6 consecutive months to be eligible for consideration
I am available for 6 months between the following dates:
From
To
What do you hope to accomplish through your volunteer service at Hartford Hospital?
I understand that documentation of an MMR vaccine, history of chicken pox or varicella vaccine, and a recent Tuberculosis (PPD) test will be required to volunteer at Hartford Hospital
I undestand that flu vaccination is mandatory during flu season.