Welcome to Volunteer Services

Please fill out this form to volunteer with us.

CHAPEL HILL UNDERGRAD APPLICATION - (College application Main hospital campus & offsite clinics)

Application Date
Last name
Legal First Name
Nickname
Middle Name
Group
E-mail
Additional languages
Gender (optional)
Ethnic Background (optional)
Date of Birth (optional)
Permanent Address
Street
City
State
Zip
Home phone
Cell Phone
Vehicle Info (or enter N/A if UNC student,or UNCH or University Employee):
Vehicle Make
Plate Number
Model/Color
Highest Degree Attained
Degree
Current Students - Freshmen/1st year limited placement selections
School
Major
Minor
Class Standing
Are you employed at UNC Health Care?
If yes, Where?
Current Occupation
Employer
Volunteer Service Areas Preferred
Choice 1
Choice 2
Choice 3
Why did you choose the service areas listed above?
What do you hope to gain from this experience?
Days and Hours Available
Emergency Contact Name
Phone
How did you learn about UNC Health Care Volunteer Services?

APPLICANT AUTHORIZATION

I hereby authorize UNC Health Care to utilize a Consumer Reporting Agency (CRA) to perform a criminal record search. I also authorize the CRA to perform a criminal record search.

I understand that the CRA does not guarantee the accuracy or timeliness of the information obtained from other sources and that UNC Health Care and the CRA shall not be liable for any inaccuracy in the information obtained from the CRA.

I understand that a consumer report will be obtained by UNC Health Care from a Consumer Reporting Agency.
I understand by completing this application that I agree to a minimum of 2 semesters of volunteer service with UNC Health Care.