Volunteer Application Form
Please complete the application to the best of your ability. If we have openings that match your interests and availability, we will reach out to you to set up an interview.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What category describes you?
*
Asian or Pacific Isander
Black or African American
Hispanic or Latino
Native American or Alaskan Native
White or Caucasian
Multiracial or Biracial
Other
AVAILABILITY: Please indicate when you ARE available. Start times vary depending on position **After 4:30 - Medical and Dental providers only**
*
8:00 AM - 12:30 PM
12:30 PM - 4:30 PM
After 4:30 *Clinical Volunteers Only*
Monday
Tuesday
Wednesday
Thursday
Friday
Are you able to commit to volunteering for one year?
*
Yes
No
Are you a Penn State Student? If yes, what year?
*
Volunteer Positions
*
Medical Services
Dental Services
Behavioral Health Services
Social Services/Eligibility
Development/Events/Marketing/Community Relations
Data Entry
Receptionist
Medical Records
Translator
Are you bilingual?
*
Yes
No
Please specify language(s)
FOR PROFESSIONAL INTERNSHIPS: If you are interested in a professional unpaid internship, indicate the field and provide academic and contact information.
*
Do you require any accommodations in order to perform the duties of a volunteer in the position which you are applying for?
*
Yes
No
Other
How did you hear about CVIM?
*
Social Media
Email
Volunteer Centre County
Word of Mouth
Other
Why do you want to volunteer with CVIM?
Additional Comments
Signature
*
Please verify that you are human
*
Submit
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