Junior Volunteer Program Application

Crouse Health sponsors a volunteer program for high school students year round.

The program is for students who will reach their 15th birthday by June 1 of the year they intend to volunteer. We ask that volunteers at a minimum complete 4 hour shifts per week. If a letter of completion or recommendation is requested, you will be required to complete 40 hours of service prior to receipt.

Because of the popularity of the program, it has been necessary to develop a priority system.

  1. The first students considered will be those who have volunteered and wish to return.
  2. The second students considered are those who have relatives working at Crouse Health.
  3. All others who have completed all their application requirements and have received their badge.

Please complete the form below as well as the attachments linked here. 

YOU MAY SEND THE PACKET TO THE VOLUNTEER DEPARTMENT IN THE FOLLOWING WAYS:
SCAN AND EMAIL TO volunteerservices@crouse.org; FAX care of Volunteer Department to (315) 470-5721 or MAIL COMPLETE PACKET TO: VOLUNTEER SERVICES OFFICE 7WT
CROUSE HOSPITAL
736 IRVING AVENUE
SYRACUSE, NEW YORK 13210

Junior Volunteer Application

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Health Career Exploration Program Member(Required)
Name(Required)
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Home Address(Required)

PARENT CONTACT INFORMATION

This information MUST be fully completed by a parent or guardian. Please provide those numbers at which we could contact you in case of emergency.

EDUCATION

EXPERIENCE

Please list any previous volunteer experience

INTEREST

Where would you like to work in the hospital? Refer to assignment descriptions and be as specific as possible.

AVAILABILITY

Please select all that apply: I am available for an 8 a.m. - noon shift on the following days
Please select all that apply: I am available for a noon - 4 p.m. shift on the following days
Please select all that apply: I am available for a 4 - 8 p.m. shift on the following days

If you are related to anyone currently affiliated with Crouse, please complete the section below.

REFERENCES

Please list the names, relationship and email addresses of two references unrelated to you. Before sending this information, contact your potential reference to get their permission. At least one reference should be a teacher, coach, employer, etc.

PARENT/GUARDIAN CONSENT

I am aware of, encourage, and support my son’s/daughter’s decision to volunteer in the Crouse Health Junior Volunteer Program. I understand that a decision to volunteer in this program requires a commitment of a minimum of 4 hours per shift and support the hospital and my child in his/her effort to honor the commitment. If a letter of recommendation or completion is requested you must completed 40 hours of service prior to receipt. I also understand that all volunteers at the hospital must meet health office requirements which include submission of copies of proof of medical examination within one year of the application and a record of inoculations. In addition, all volunteers are required to undergo a tuberculosis skin test administered by our health office. Your signature indicates that we have your permission to complete the above requirements.
Parent/Guardian Name
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Click here if you prefer to complete the application via PDF