Volunteer Application Form

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.
I acknowledge that I am applying to volunteer at Centre Volunteers in Medicine located in State College, PA*

Yes
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

AVAILABILITY: Please indicate when you ARE available. Start times vary depending on position*

Are you able to commit to volunteering for one year? (You must be available for a full year to be considered for any volunteer position)*

YesNo
Are you a College Student? If yes, what year?*
Volunteer Positions *(You must be licensed in PA to be considered for any clinical position. There are no opportunities for shadowing in any clinical position at this time.)*

Case Management *(Clinical)Eligibility - Spanish speaker a plus!Social Media/Events/Blog/DataData EntryReceptionist - Monday morning shift or afternoon shift or Thursday afternoon shiftTranslator
Are you bilingual?*

YesNo
Please specify language(s)
Do you require any accommodations in order to perform the duties of a volunteer in the position which you are applying for?*

YesNoOther
How did you hear about CVIM?*

Social MediaEmailVolunteer Centre CountyWord of MouthOther
Additional Comments
Additional Questions

Our funders require us to collect the following information. You may choose to not answer.
Which of the following best describes your race and ethnicity?

Asian/Asian American/Pacific IslanderBlack/African American/AfricanHispanic/Latino/Latina//LatinxNative American/IndigenousWhite/Caucasian/EuropeanMultiracial/MultiethnicUnknown or decline to stateOther
Which of the following best describes your gender?

MaleFemaleNon-Binary (identifying as any gender other than female or male)Unknown or decline to state
Signature*

Clear
Please verify that you are human*
Should be Empty:

Additional Questions