College Volunteer Application

The College Volunteer Program at Penn Medicine Princeton Health (PMPH) provides an opportunity for those on a career path in the medical field to gain valuable hospital experience while giving back to the local community.

Sessions run parallel to traditional school semesters. College Volunteers serve once a week for a 3-hour shift, are expected to complete a minimum of 12 weeks of service each for both Fall & Spring semesters, and are required to maintain excellent attendance. Summer Session, in general, will run 12-13 weeks between May and August based on your school's semesters.

Missing more than 3 weeks of service per semester is grounds for dismissal from the program.

APPLICATION DATES

College students (undergraduates) must adhere to the application schedule as listed on the website.

Applicant Information

Title

* First name

* Family/Last name

Preferred First Name (if different from your legal name)

Middle name

DOB (optional)

Address

* Home Street Address

Apt./P.O. Box/Suite

* City

State

* Zip/postal

Seasonal Address

If you do not live locally, please indicate your seasonal (or local) address.
For example, college students who live out of state but live on campus during the school year, should enter their on-campus address.

Seasonal Street Address 

City

State (as combo)

Zip/postal

Personal Contact Information

* Phone (Home)

Phone (Mobile)

Phone (Other)

Preferred phone type

* E-mail

Emergency Contact Information

* Emergency Contact Name

* Relationship to you

* Phone

Referral and Motivation Information

How did you hear about our program?

Main reason for wanting to volunteer

Do you have a current or previous affiliation with PMPH?

If you have been a patient,caregiver,volunteer, or have a current/previous affliation to the hospital please select all that apply.

* Please tell us why you are interested in serving as a volunteer with Penn Medicine Princeton Health. Be sure to include areas of interest or specific assignment requests that you would like us to consider.

Education

Please indicate the highest level of education completed.

Education

* School/College/University Attended/Attending

* Degree/Major

*  Year Graduated or anticipated Graduation Year

Employment Experience - Penn Medicine

Please check if you have ever worked for any entity of Penn Medicine

If yes, work location

Dates of Employment

Reason for leaving

Application Certification
By checking the boxes below, I consent to the below statements and certify that all information in this application is true and correct as of today's date:

* I give permission for any necessary medical treatment to be given in the event of illness or an injury.

* I understand that any misstatement, omission or misleading information given in my application or interview or in connection with other PHPM records may result in the rejection of my application, the withdrawal of any offer of placement or dismissal after acceptance.

* I understand that a volunteer assignment and any related documents are in no way a contract, promise, or consideration of paid employment. I know that I will not be compensated for my service.

* Students are expected to commit to serving a consistent schedule -- 1 day a week for a 3-hour shift -- for the entire session (semester) for which you wish to volunteer. We require a 2 session commitment. Reference letters will not be provided for service less than 2 complete sessions.  

* I release from all liability and responsibility all persons and entities, requesting or supplying information about any information provided on this application, including my present employer if contact is authorized. Upon leaving my service with PMPH, I authorize the release of information in connection with my volunteer service.

* I understand that I am required to complete PMPH volunteer orientation and any training requirements for the position(s) I am placed into, as in effect from time to time.

* I hereby authorize and permit PMPH to take, obtain and make use of photography and publicity of myself, as it relates to my volunteer service. I understand that such photography, interviews, and information may be used for inclusion in media reports and in PMPH publicity materials and publications that have been discussed with me prior to their publication. I understand that this will be done without compensation to me.

* If accepted, I will abide by PMPH rules, regulations, policies and procedures, which I understand are subject to change by PMPH.

* I agree to notify PMPH if any of the information I provide during the application, interview and on-boarding process changes at any time during the course of my service with PMPH.

* I understand that my volunteer service may be terminated at any time, with or without cause, in PMPH sole discretion.

Princeton Health is an Equal Opportunity and Affirmative Action employer. Candidates are considered without regard to race, ethnicity, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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Use your mouse or touchpad to digitally sign below.

* Name (First Name Last Name)

Application date