Teen Volunteer Application

All questions must be answered completely for this application to be considered.
Name
Birthdate
Address
City
State
Zip
Home Phone
Cell Phone
Email
Name of school
Current grade
  9
 10
 11
 12

Parents/Legal Guardian (address/phone number if different than above)
Mother or Guardian
Father or Guardian

Person to Contact in Case of Emergency
Name
Relationship
Primary Phone
Alternate Phone
Has someone close to you passed away in the past 12 months?
  Yes
 No
If yes, please explain the circumstances.

Volunteer History
Name of Agency
Start Date
End Date
Describe Duties
Name of Agency
Start Date
End Date
Describe Duties
Why do you want to be a Hospice of Northwest Ohio volunteer?
Please list any hobbies, interests or activities that you enjoy:

As a Hospice of Northwest Ohio Teen Volunteer, I agree to volunteer a minimum of four hours per month for a period of at least six months. I understand that I am required to attend orientation before I can begin volunteering.

I acknowledge that submitting this application is not a guarantee of a volunteer position and I must complete an interview process.

By entering my name below, I certify that the information provided above is true and accurate.
Enter Name Here
 I confirm that this is my digital signature.
Parent or Guardian Name
 I confirm that this is my digital signature.
Date

Please submit one letter of recommendation with this application. The letter must be from someone who is not a family member. This is required in order to be considered for an interview.
Upload a letter of recommendation.