Volunteer Application
Volunteer Contact Information
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.
Date of Birth
*
-
Month
-
Day
Year
Date
Emergency Contact Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Additional Information
Do you attend a university?
*
Do you have any special training?
*
What are your reasons for wanting to become a volunteer with UNC Health Appalachian?
*
Approximate length of commitment (must be available for at least 100 hours over an indeterminate period of time)
*
Agreement
I hereby certify that my answers on this application and any resultant interview are true and correct and that any misrepresentation or omission of facts, or misleading or false information on my part will be grounds for dismissal as a volunteer. Acceptance as a volunteer is contingent upon satisfactory references, verification of information submitted on this application. I therefore authorize you to make such investigations and inquiries as you deem necessary in arriving at the decision to accept me as a volunteer. I authorize that all employers, schools, or references thus contacted be released from all liability in answering questions related to my application.
Signature
*
Submit
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