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
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Yes
Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
AVAILABILITY: Please indicate when you ARE available. Start times vary depending on position
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8:00 AM - 12:30 PM
12:30 PM - 4:30 PM
Monday
Tuesday
Wednesday
Thursday
Friday
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)
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Yes
No
Are you a College Student? If yes, what year?
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Volunteer Positions Available *You must be licensed/certified in PA to be considered for any clinical position. *There are no opportunities for shadowing in any clinical position at this time.
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Case Management (Clinical)
Data Entry
Front Desk Receptionist - Monday morning or afternoon shift, Thursday morning or afternoon shift, Friday morning or afternoon shift available *Not accepting students at this time for this position*
Translator
Social Media
RN/LPN (Clinical)
Physical Therapist (Clinical)
Pharmacist (Clincial)
Dental Assistant (Clinical)
Dental Hygienist (Clinical)
Dentist (Clinical)
Doctor (Clinical)
Couselor (Clinical)
Are you bilingual?
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Yes
No
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?
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Yes
No
Other
How did you hear about CVIM?
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Social Media
Email
Volunteer Centre County
Word of Mouth
Other
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 Islander
Black/African American/African
Hispanic/Latino/Latina//Latinx
Native American/Indigenous
White/Caucasian/European
Multiracial/Multiethnic
Unknown or decline to state
Other
Which of the following best describes your gender?
Male
Female
Non-Binary (identifying as any gender other than female or male)
Unknown or decline to state
Signature
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Please verify that you are human
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Submit
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