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Summer Youth Program Application

Application Information

All fields with asterisk (*) are required.

Have you ever worked at St. Mary's Medical Center?
Do you have any physical limitations, medical limitations, or mental disorders that would impair your ability to perform as a volunteer at St. Mary’s Medical Center without any supplemental assistance?
Have you ever been convicted of a crime? (an affirmative response will not automatically disqualify you from being considered)

Emergency Contact Information

Please list someone we can contact in case of an emergency.

Name of Friends or Relatives Employed or Volunteering at St. Mary’s Medical Center

Personal References

Please list three personal references (Employers, Volunteer Supervisor, Teacher, etc. – No Relatives)

Short Response

1. What is your previous volunteer experience? For each experience, please include the following information.

4. What special skills, interests or strengths would you offer as a volunteer? Please note if any of the following categories are applicable and elaborate.

9. Volunteer interest in: 

Education and Work Experience

Please include university attended, area of study and degree obtained

GPA (Proof is required) - upload copy
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This field is required

Please check the answer that apply to you
Please upload your completed Letter of Recommendation, Program Information and Guidelines and Volunteer Expectations forms.
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This field is required

I hereby affirm that the information provided on this application is true and complete to the best of my knowledge, and agree to have any of the statements verified by St. Mary’s.  I understand that providing any false or misleading information or any omissions may disqualify me from further consideration as a volunteer and may result in my immediate termination even if discovered at a later date.  I authorize all references provided in this application, as well as all other individuals to provide all information they have about me.  Furthermore, I agree to cooperate in such investigation and release from liability or responsibility, the Medical Center and all persons and entities acting on its behalf, and all persons and entities requesting or supplying such information.

Please enter date in this format: mm/dd/yyyy

Enter your date of birth in this format: mm/dd/yyyy

Additional Requirements