Sparrow Teen Application

Please note that the Teen Program is available to individuals 16-17 years old AND who have completed the 10 Grade.

Teen Volunteer Contact Information

* First name

Middle name

* Family/last name

* Address/Apartment #

* City

State (as combo)

* Zip/postal

* Primary Phone Number - (XXX)XXX-XXXX

* Volunteer's E-mail

* Date of Birth - MM/DD/YYYY

* Name of High School

* Graduation Date - MM/DD/YYYY

Parent or Guardian's Information

* Contact name

* Address/Apartment #

* City

State (as combo)

* Zip/postal

* E-mail

* Primary Phone - (XXX)XXX-XXXX

Secondary Emergency Contact (If first cannot be reached) - (XXX)XXX-XXXX

* Contact name

* Phone (Home) - (XXX)XXX-XXXX

* Allergies and significant medical conditions we should be made aware of to ensure the teen is successful

Past volunteer Experience

Activity/Organization

Major Responsibilities

Employment History

Do you currently have a paid job?

If yes, how many hours a week do you work?

Employer's Name (Current or past)

Supervisor Name

Describe Duties

Personal Reference Check

Please provide the name and e-mail address of the individual that you would like us to contact for your personal reference. They will recieve an e-mail they will need to fill out.

Name

E-mail

Extra Curricular Activities

Activities and Dates (Ex. Volleyball, Sept-Nov; Musical, Jan-Feb)

* What motivated you to seek volunteer opportunities at Sparrow?

* What do you want to achieve from your volunteer experience?

* What day and time frame works best for you to volunteer? For example: Monday 4-6 or 6-8

Are you able to serve one year and make a weekly commitment to a two hour shift?

Have you ever been convicted of a misdemeanor or a felony?

If yes, please explain.

Tobacco & Smoke Free Health System Policy

Sparrow promotes a healthy and safe environment for all Associates, Physicians, Volunteers, Patients and Visitors. It is Sparrow Health System's policy to provide a tobacco free workplace and environment of care by prohibiting smoking and the use of tobacco products on its grounds and properties, and in its facilities. Smoking and tobacco usage are prohibited in all buildings owned and leased; including company owned vehicles and personal vehicles parked on Sparrow Health System's property. This policy includes the use of electronic cigarettes (otherwise known as e-cigarettes) as they are regulated by the U.S. Food and Drug Administration as a tobacco product or vaporizer pens. All Caregivers, Physicians, Volunteers and Visitors are required to comply with the Tobacco Free policy. This is in compliance with regulations and the directives of the Joint Commission standards.

Thank you for your interest in Sparrow Volunteer Service's Teen Program. You will recieve an e-mail conformation immediatly following the submission of this application.