Volunteer Application Form

Click here to download the volunteer application form. You may complete this form and mail them to Volunteer Application Form, New London Hospital.

First Name:

Last Name:

Phone:

E-mail:

Address:

City:

State:

Zip:

Emergency Contact & Phone:

Previous volunteer experience:

When you think of volunteering, what kinds of things interest you?

List any special talents or skills that you would be willing to share:

Are you interested in short term projects?

Do you speak a foreign language?

If so, please list:

Please select the days that you will be available:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

AM

PM

 

Please list two people who would be willing to serve as a personal reference. Please include Name, Address & Phone.

Reference 1

Reference 2

Signature:

Date:

FOR OFFICE USE ONLY
Date of Application Received: ______/_______/_______      

Orientation Date: ______/_______/_______

Service Area: _______________________________________      

Shift: ________________________

Department Supervisor: ___________________________________________