Welcome to Rochester General Hospital Volunteer Services Department

College (Non Medical Pathfinder Program) Student Application

To be eligible to complete this application, you must be currently enrolled in college AND willing and able to volunteer for a minimum of 3 hours a week for at least 14 weeks. Do you meet those eligibility requirements?
Personal Information
Middle Initial
Name prefix
First Name
Family/Last Name
Gender
DOB
Application date
Home/Mailing Address
Street
Apt
City
State
Zip/postal
Home phone
Mobile Number
E-mail Address
Emergency Contact
Contact name
Relationship
Home phone
Work phone
College/Grad School
Other College (not listed)
College Graduation (Anticipated Date)
Participation Information
How did you hear about our program?
Why do you want to volunteer at Rochester General Hospital?
College students not in the Medical Pathfinder Program can volunteer in any of the following assignments. Which most interest you?
Helping Hands on Demand
ED Patient-Family Companion
Visitor (Guest) Services
Cancer Center Companion
Patient Discharge
Pediatric Family Lounge
Friendly Patient Companion
Course, Program, or Community Service Hour Requirement
I have a course, program, or community service hour requirement to complete.
How many hours do you need to complete?
By what date do you need to start?
By when do you need to finish?
References
1)
Name:
Street:
Phone:
Email:
City:
State:
Zip Code:
2)
Name:
Street:
Phone:
Email:
City:
State:
Zip Code:
Signature
Have you ever been known by any other name?
If yes, what name were you known by?
When were you known by that name?
Please read and sign:I understand that any falsification of information on this application may result in immediate termination of the application/on-boarding process or as a volunteer with the Rochester General Health System.I authorize the Volunteer Services Department to contact my references.I agree that my acceptance as a volunteer is contingent upon my passing a medical examination. Please state below any physical condition you have which should be considered when you are assigned a volunteer position in the hospital, or which we should know in case of emergency.I understand that a volunteer is expected to observe confidentiality with respect to all patient information at all times, and that failure to do so may result in my personal liability to the patient and/or the hospital.
I agree


For office use only:
Health Screening
Background Check
Orientation
Wheelchair Training
Canine Visitation