Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Helen Keller Hospital

HKH Volunteer Application

Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sex.
* Application Date
* First Name
  Middle Initial
* Last Name
  Preferred Name
* Address (City, State, Zip)
* Home Phone
  Additional Phone (Cell, etc.)
  Highest level of education
  Do you need any special accommodations to serve as a volunteer?
  Are there any hours that you cannot work or do you have preferences about the hours that you can work?
First Reference
* Name
* Phone
Second Reference
* Name
* Phone
  Is there any particular area of the hospital that you are interested in working?
  How old are you?
  Have you ever been convicted of a felony or misdemeanor?