THANK YOU for taking the time to complete this volunteer application! This form is for individual volunteers only. If you are interested in a group volunteer opportunity, please introduce yourself to


 Here are some hints to help you through the application. 


1) Please complete this form carefully; it is part of your volunteer record. Complete as many fields as you can. 


2) For open-ended questions, you may wish to use a word processing program to write your text and then paste it into the form.


3) If you need to write additional comments, please use the box at the bottom of this page. 


4) If you have any questions or concerns about the form, please contact us by email at

How did you hear about us?
  • Facebook
  • PWH website
  • Word of Mouth
  • Flyers or other information displayed
  • Email notice
  • Group Volunteer Experience
  • Other
Why are you interested in volunteering at PWH?*

Contact Information

State / Province*
Confirm Email*

More about you

Please describe your status. Pick all that apply.*
  • Medical Doctor
  • Registered Nurse
  • Physical Therapist or Occupational Therapist
  • Registered Nurse Practioner or Physicians Assistant
  • High School Student
  • College or Graduate School Student
  • Working Full-time
  • Working Part-time
  • Retired
  • Other (please specify in the next section.)
Tell us a little bit about your employment or student background*
Tell us a little about your past experiences as a volunteer.*

Your interests and availability

Volunteer Interest Areas-please pick up to 3 that reflect your interests.*
  • Administrative (reception, computer work, research, outreach)
  • Marketing (social media, website, copywriting, graphics)
  • Medical Supply Processing
  • MMC Weekend Runner
  • Events Committee Member
  • Truck Driver (25+ with clean driving record; can lift 50lbs; pick-ups and delivery)
  • Other (if you have specific skills or a new idea, please let us know in the comment box)
Availability to volunteer -please pick all that apply.*
  • Tuesday morning
  • Tuesday afternoon
  • Wednesday morning
  • Wednesday afternoon
  • Thursday morning
  • Thursday afternoon
  • Friday morning
  • Friday afternoon
  • Saturday morning
  • Saturday afternoon
  • Other (specify in comment box)

Details we need to know

Date of Birth (MM/DD/YYYY)
Volunteer Emergency Contact Name*
Volunteer Emergency Contact Phone*
Volunteer Emergency Contact Relation*
Additional Comments

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