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Volunteer Application for Adults
College Volunteer Application Form
Thank you for your interest in volunteering. Please have all necessary information available when completing this application, there is no option to save and return. Thank you
New User Details
User ID
User ID (verify)
Password
Password (verify)
*
First name
M.I.
Gender
Female
Male
Not disclosed
*
Family/Last name
Preferred Nickname
Address
*
City
*
State
*
Zip/postal
Work phone
Home phone
*
Mobile phone
*
E-mail
Emergency Contact Information
*
Contact name
*
Relationship
Address
City
State
Zip/Postal
Home phone
*
Mobile phone
Work phone
E-mail (if applicable)
Additional Information
Volunteer source
n/a
Another Volunteer
Billboard
Career Fair
Caregiver
Church
Employer
FCCC colleague
FCCC Website
Friend
Lisa's Army
Newspaper
Other
Patient
Patient to Patient
School
TV/Radio
Volunteer Match
Volunteer website
Walk-up
How long can you commit to volunteering?
Weeks
Months
Years
Other
Primary Language
Afrikaans
Akan
Aklanon
Albanian
Aleut
Algerian
Amharic
Anishinaabemowin
Arabic
Aramic
Arawakan
Armenian
ASL
Avestan
Ayapathu
Aymara
Azeri
Bamwe
Bantu
Basa
Basque
Belarusan
Bemba
Bengali
Berber
Bicol
Bisaya
Bobangi
Bosnian
Brahui
Breton
Bukusu
Bulgarian
Burmese
Butuanon
Byelorussian
Cambodian
Cantonese
Catalan
Cayuga
Cebuano
Ch'ol
Chaldean
Chamorro
Chechen
Chewa
Chinese
Chinook
Chorti
Coptic
Cree
Creole
Croatian
Czech
Danish
Dari
Demonh'ka
Dinka
Dothraki
Dutch
Ebu
Eggon
Egyptian
Emakua
English
Eskimo
Estonian
Etruscan
Fang
Faroese
Farsi
Filipino
Finnish
Flemish
Frankish
French
Fujanese
Fuzhounese
Gaelic
Gaelic (Irish)
Gaelic (Scottish)
Gaelic (Welsh)
Galician
Gamilaraay
Ganda
Gaulish
Gbari
Georgian
German
Gevove
Gilbertese
Gothic
Greek
Guarani
Gujarati
Guyanese Creole patois
Haida
Haitian Creole
Hakka
Halaka
Hausa
Hawaiian
Hebrew
Hiligaynon
Hindi
Hmong
Hokkien
Hungarian
Icelandic
Igbo
Ilocano
Ilonggo
Indonesian
Ingush
Inuit
Inupiat
Italian
Japanese
Jita
Kachi
Kakwa
Kalanga
Kannada
Kapampangan
Kapampangan
Karelian
Kashmiri
Katcha
Kazakh
Kerewe
Khmer
Khowar
Kiga
Klallam
Klingon
Kongo
Konkani
Korean
Koyo
Kurdish
Lakhota
Laotian
Latin
Latvian
Lebanese
Lingala
Lithuanian
Lozi
Luganda
Luwian
Lycian
Lydian
Mabwe
Macedonian
Malay
Malayalam
Maliseet
Maltese
Mandarin
Mandinka
Manx
Maori
Mapudungun
Marathi
Masaba
Mawu
Mayan
Mayangna
Miami
Minbari
Miskitu
Mixtec
Mohawk
Mongolian
Mpongwe
Nahuatl
Nande
Nauruan
Navajo
Ndebele
Nepali
Nkwen
Norwegian
Nyamwezi
Occitan
Ojibwe
Olkola
Olutec
Onondaga
Oriya
Oromo
Oykangand
Pahlavi
Pakahn
Pali
Papiamento
Pashto
Pende
Persian
Phoenician
Phrygian
Pidgin
Piraha
Polish
Popoluca
Portuguese
Potawatomi
Prussian
Punjabi
Quechua
Rasta
Rejang
Romanian
Romany
Rotuman
Russian
Saanich
Samoan
Sanskrit
Seneca
Serbian
Seri
Shanghainese
Shi
Shona
Sicilian
Signing Exact English
Sindhi
Sinhala
Slovak
Slovene
Sogdian
Somali
Sorbian
Spanish
Sranan
Sudovian
Sumerian
Swabian
Swahili
Swedish
Tagalog
Taishanese
Taiwanese
Tajik
Tamazight
Tamil
Tarahumara
Tarok
Tatar
Telugu
Teochew
Thai
Thracian
Tibetan
Tigrinya
Tlingit
Tocharian
Tongan
Treu Chau
Turkish
Turkmen
Twi
Ukrainian
Ulwa
Umbrian
Urdu
Uyghur
Uzbek
Venda
Veps
Vietnamese
Visayan
Votic
Warlpiri
Welsh
Wolof
Xhosa
Yaka
Yao
Yemba
Yiddish
Yoruba
Yupik
Zoque
Zulu
Please list any additional languages
Uniform Size
XS
S
M
L
XL
XXL
Skills
Administration/Office
Artist
Audio/Visual
Caregiver
Child Care
Computer - Data entry
Computer - IT general
Construction - Carpentry
Construction - Electrical
Construction - General
Construction - Painting
Construction - Plumbing
Crocheting
Custodial
Event Planning
Food Services - Delivery
Food Services - Preparation
Fundraising
Gardening
Grant Writing
Graphic Design
Knitting
Language/Translator
Law Enforcement
Legal
Library
Marketing/Communications
Medical - Doctor/Physician
Medical - First Aid
Medical - General
Medical - Nursing
Musician
Photography
Political/Government
Public Relations
Public Speaking
Sales/Cashier
Sports - Coaching
Sports - Official
Survivor
Transportation - Driver (bus/van)
Transportation - Driver (car)
Transportation - Emergency
Transportation - Moving
Transportation - Parking
Video Production
Writing/Reporting
What type of assignment(s) interest(s) you?
Patient Services
Research
Clerical/Administrative
Technical/Business
Other
If any, please indicate other interests
I have been accepted into a Lab or Program at FCCC
Yes
No
*
Lab Name
Lab Contact
If you know your start date, please enter it here:
Are you a student of Temple (any program) or Drexel (graduate students only)?
Yes
No
What School/College
Temple
Drexel
Which School/Program?
Medical School
Undergraduate
Graduate (non-medical)
*
TUID
Major or Program
*
Expected Graduation Date
Street Address
City
State
Zip/Postal
Year Round Volunteer
Availability
Time slots marked with (*) indicate very limited positions.
Monday
7am to 9am*
9am to 2pm
1pm to 5pm
5pm to 9pm*
Any time
Tuesday
7am to 9am*
9am to 2pm
1pm to 5pm
5pm to 9pm*
Any time
Wednesday
7am to 9am*
9am to 2pm
1pm to 5pm
5pm to 9pm*
Any time
Thursday
7am to 9am*
9am to 2pm
1pm to 5pm
5pm to 9pm*
Any time
Friday
7am to 9am*
9am to 2pm
1pm to 5pm
5pm to 9pm*
Any time
References
Please list two people (other than relatives or friends) who would be willing to serve as personal references.
Reference 1
Relationship to Reference (cannot be friend or relative)
Parent
Employer
Pastor/religious leader
Law enforcement
Teacher
Professional
Other
*
Name
*
E-mail
Reference 2
Relationship to Reference (cannot be friend or relative)
Parent
Employer
Pastor/religious leader
Law enforcement
Teacher
Professional
Other
*
Name
*
E-mail
Attestation of Application Answers and Information Provided
I understand that the statements made in my volunteer application are true and correct and have been given voluntarily. I understand that falsification of any information is grounds for dismissal. I voluntarily give TUHS/FCCC the right to make an inquiry of my past experience and I agree to cooperate in such inquiries and release from all liability or responsibility all persons, companies, and corporations supplying such information. I voluntarily give TUHS/FCCC permissoion to contact my references provided above. I understand that I will not be compensated for my services as a volunteer and I am not required to volunteer my services. I understand that acceptance as a volunteer at TUHS/FCCC is contingent upon satisfactory completion of all pre-placement procedures which include but are not limited to orientation, an interview, criminal background investigation(s), completion of HIPAA Certification and completion of required health screenings. I understand that upon my successful completion of the volunteer service on-boarding processes required at TUHS/FCCC and the approval for placement by volunteer Services staff, I will become a volunteer. I agree to abide to the policies of TUHS/FCCC and if I do not, this may result in disciplinary actions. I am aware of and will honor the schedule commitment I make during my interview with Fox Chase Cancer Center Volunteer Services.
*
I have read the statement above and I understand and agree.
*
Name
*
Date
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clear
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Signature