Emergency Contact:
Thank you for your interest in volunteering at the Westchester Medical Center. Your application will be reviewed and you will be contacted to come in for an interview. For your information, volunteer candidates must meet certain requirements before volunteering. The requirements are: HEALTH SCREENING: Volunteer candidates are required to have a physical examination and receive clearance from Westchester Medical Center. The Volunteer Department will make an appointment for you to have your medical records reviewed by the Occupational Health Center. HOSPITAL ORIENTATION: Attending a hospital orientation is mandatory prior to volunteering. You will be scheduled for hospital orientation which usually lasts a full day. REFERENCE FORMS: In addition, all volunteers must download and complete two reference forms and bring them, along with any other requested material, to their interview. Professional references are preferred. If you have any questions, please contact the Volunteer Office at (914) 493-7850 APPLICANT: Please complete ALL questions. The following information is necessary in order to obtain a medical record number. Thank you.
* Indicates required information
Volunteer opportunities vary depending on the age of the volunteer. Please select your age group: *	16-18 years 18-21 years 21 and older
I would like to apply for a volunteer position in: *	University Hospital Maria Fareri Children's Hospital Both
In addition to hospital volunteering I would like to participate as a community volunteer during community events for: *	University Hospital Maria Fareri Children's Hospital Both
Do you speak Spanish? *	Yes No
Full Name *
Street Address 1 *
City *
State *
Zip *
Home Phone *
Work Phone
Cell Phone
Date of Birth *	(mm/dd/yyyy)
Email Address
Name
Relationship
Phone Number
Education (check Highest Completed)
High School	1 2 3 4
College	1 2 3 4
Graduate	1 2 3 4
If you are currently a student, where are you enrolled?
Community Affiliations
Have you previously volunteered at WMC? *	Yes No
If yes, dates:
Please check off the times that you are available to volunteer:
Morning	Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Afternoon	Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Evening	Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Volunteer Experience
1. Name of Agency
1. Date	(mm/dd/yyyy)
1. Title/Duties

2. Name of Agency
2. Date	(mm/dd/yyyy)
2. Title/Duties

Volunteer Questionnaire
PLEASE RETURN THIS QUESTIONNAIRE WITH YOUR VOLUNTEER APPLICATION
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1. Why are you interested in volunteering at the Maria Fareri Children's Hospital at WMC or Westchester Medical Center? Please describe any previous experiences that have influenced your decision to volunteer here
2. What volunteer positions are you interested in?
3. Would you prefer direct patient contact or non-patient contact? Why?
4. If you are applying for a volunteer position in the Children's Hospital, please describe your experiences with children?
5. Please list any special skills, talents, and/or hobbies.
6. Do you like to work alone or with other people?
7. Please describe other commitments. (i.e. community, school, etc.)
8. What do you expect to gain from your volunteer work?
9. If you could create the perfect volunteer opportunity for yourself, what would you be doing?
10. How will you respond if the volunteer opportunity does not meet your expectations?
11. How will you handle challenging situations as a volunteer?
12A. Have you experienced the death of someone close to you in the last 2-3 years? *	Yes No
12B. If yes, what was your relationship?
13. How do you think you would handle your feelings if you were working with a critically ill child or adult?
14. What would you like for us to know about you that we haven't asked?

Scenario: You have been volunteering for several months and have gotten close to one particular patient and their family. The family has been making requests that require you to go beyond the call of duty as a volunteer.
They have asked for your phone number or your e-mail address and have asked you to visit them at times other than your assigned volunteer shift. How do you feel about this situation and how would you handle it?