Please complete this application form if you are 16 or 17 years old, and you are interested in becoming a Stamford Health volunteer. Once you complete the form, click the Submit button at the bottom. Please consider our requirements for your time commitment (listed on our website) prior to completing the application. Once you complete the form, click the Submit button at the bottom.

Name and address

Demographic Information

If you are the age of 18 or older, please fill out this application instead: Adult Volunteer Application

Availability

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Essay

Qualities and Characteristics

Contacts

Please list an emergency contact and your parent or guardian's information.
Emergency contact
Parent/Guardian contact

Referral

Assignment Preference

Please share with us your preference for your assignment. Note: We cannot guarantee your placement in your preferred assignment due to availability and other circumstances.

Reference

Please provide the name and contact information for your guidance counselor or teacher who can speak to your character.

Disclaimer

If I am selected as a volunteer, I understand and agree that I have the right to terminate the volunteer relationship at any time and for any reason and Stamford Health have a similar right. The information supplied by me on this volunteer application is true and complete to the best of my knowledge. I understand that the discovery of any misrepresentation or omission of facts in the volunteer application may result in revoking my volunteer status.

The information supplied by me on this volunteer application is true and complete to the best of my knowledge.

My signature below indicates that I understand and agree with all above statements.

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