Reiki Application

I am over 18 and out of High School
Application date
Family/last name
First name
Street Address
Home phone
Do you speak any additional languages?
Contact Information
Present School
Highest grade
Physicians phone
Physicians name
Name of your emergency contact
Home phone
Current / Most Recent Employer
Supervisor Name
Business Phone
How did you hear about our program?
What date are you available to begin volunteering? (A minimum 6-month commitment is required)
Please tell us when you are available. Check all that apply
Monday AM
Monday PM
Monday Evening
Tuesday AM
Tuesday PM
Tuesday Evening
Wednesday AM
Wednesday PM
Wednesday Evening
Thursday AM
Thursday PM
Thursday Evening
Friday AM
Friday PM
Friday Evening
Saturday PM
Saturday Evening
Saturday AM
Sunday AM
Sunday PM
Sunday Evening
Check here if you are required to do Community Service
If yes, how many hours do you need to complete?
By what date do you need to complete your hours?
Why do you want to provide reiki in a hospital Setting?
Are you Reiki trained?
If yes, what is your level of Reiki training?
Where did you recieve your training?
What types of modifications of the Reiki practice do you think may be necessary in a hospital setting?
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.