Adult College Application | UCI Health | Orange County, CA

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Home > Volunteer Services > Adult Volunteers

UCI Health will see you now: Welcome to our new co-workers and patients from Fountain Valley, Lakewood, Los Alamitos and Placentia Linda!

In this Section

In order to successfully submit the form, please ensure that all fields marked with an asterisk (*) are completed.

Contact Information

First Name *

Last Name *

Nickname

Address *

City, State and ZIP Code *

Phone Number *

Email *

Gender * Male Female Other

Date of Birth (MM/DD/YYYY) *

Are you 18 or older? Yes No

Are you applying as an adult volunteer or college student? * Adult Volunteer College Student

Local Emergency Contact

Emergency Contact Name

Relationship

Contact Phone Number

Are you currently in school? Yes No

If yes, where?

Field of Study

Career Goal

Most Recent Work Experience

Employer

Supervisor Name

Employment Dates (from/to)

Job Title

Job Duties

What days and times are you available for volunteer assignments? *

Why are you interested in volunteering?

In which areas are you interested in volunteering?

List any special skills and qualities you have that would benefit our volunteer program, including foreign languages spoken fluently:

Have you previously volunteered at UCI Medical Center? If so, when?

Please summarize your previous volunteer experience:

How did you hear about the volunteer program?

Conditions of Service

I understand that acceptance and placement into positions within volunteer services is contingent on the successful completion of a background investigation and successfully completing all required post offer medical health checks prior to the first day of * Yes No

Commitment Statement

I understand and agree that in the performance of my duties as a volunteer with UCI Health I must abide by all policies and procedures, including to hold as strictly confidential all medical information that I may obtain directly or indirectly concerning p *
By checking this box, I certify that I have read the above statements and agree to conform to all the rules and standards of UCI Medical Center

Today's Date

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Adult Volunteers

College Volunteers

Cuddler Program

Volunteering at Fountain Valley

Child Life Volunteer Program

High School Volunteers

Irvine Clinical Experience

Patient Experience Internship Program

Music to Heal Program

Pet Therapy Program

Student Research Programs

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Volunteer Services

Adult Volunteers

College Volunteers

Cuddler Program

Volunteering at Fountain Valley

Child Life Volunteer Program

High School Volunteers

Irvine Clinical Experience

Patient Experience Internship Program

Music to Heal Program

Pet Therapy Program

Student Research Programs

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