Have your doctor’s office complete the

January 4, 2016

Dear junior volunteer applicant:

Thank you for your interest in the 2016 summer junior volunteer program. Enclosed you will find an application, a service area request form, an essay form, two teacher recommendation forms, a parental consent form, a TB screening form, and an immunization form.

Please complete the application, service area request form, essay, and TB screening form and ask your parent/guardian to sign the two consent forms. Ask two teachers to complete the recommendation forms and place them in a sealed envelope with their signatures across the seal. Have your doctor's office complete the immunization form. In order to be considered in the selection process, all materials, including a completed immunization form, must be submitted to the volunteer services office by Monday, Feb. 29, 2016.

Once the application materials have been received, potential candidates will be contacted to schedule interviews in March. After careful consideration, accepted candidates will be notified in April. If you are accepted, you will then be required to complete several more steps before the actual volunteer program begins in June. Please be sure that you will be able to complete all of these steps in the noted time frame before making application.

Feb. 29, 2016 ? Completed applications, including an immunization form, are due to the volunteer office. March ? Potential candidates will be contacted for interviews. A parent/guardian must accompany the

candidate to the interview. April ? Accepted candidates will be notified by letter. May ? Accepted candidates must attend a mandatory orientation session. Two sessions are being offered,

you need only attend one. If you are unable to attend one of these orientation sessions, please consider applying to the program next year.

Session A ? Saturday, May 14, 2016, 8:30 a.m. to noon Session B ? Saturday, May 21, 2016, 8:30 a.m. to noon June 20 ? Aug. 13, 2016 ? Eight-week junior volunteer program. Junior volunteers are required to complete a minimum of six hours per week. Junior volunteers are permitted two weeks for vacation, camp, mission trips, etc. Students who will be away more than two weeks during the summer program should not apply.

Thank you again for considering the Novant Health Forsyth Medical Center junior volunteer program for your summer volunteer opportunity. I look forward to hearing from you.

Sincerely,

Melissa Williard, guest services manager

Novant Health Forsyth Medical Center 3333 Silas Creek Parkway Winston-Salem, NC 27103 336-718-5738

Junior volunteer application

Date_________________

Name: ___________________________________________________________

Last

First

Middle

Address: __________________________________________________________

Street Address

City

State Zip Code

Email: ____________________________________________________________

Please attach recent photo

Home phone #: _______________ Cell phone #: _______________ SSN (last 4 digits): ______________

Current school: _____________________________________________ Grade: _____ D.O.B.: ___/___/___

Age on 6/20/16:____ In case of emergency, contact: _________________________________ Relationship: __________________

Address: ___________________________________________________ Email: ________________________

Home phone #: _______________ Cell phone #: _________________ Work phone #: ________________

Person responsible for transportation: __________________________ Relationship: __________________

Address: _____________________________________________ Home #: __________ Work #: ___________

Please list any hobbies, skills or special interests:

Please list any clubs or organizations to which you belong:

How did you learn about the junior volunteer program?

Please return all application materials to volunteer services, Novant Health Forsyth Medical Center by Monday, Feb. 29, 2016

jv application 2016

(Office use only) Date received: _____________

Interview date: _____________

Uniform size: ______________

Novant Health Forsyth Medical Center Junior volunteer program

Service areas

Name: ___________________________________________

Listed below are the service areas in which junior volunteers may be placed. Please rank your choices, 1 through 7, with 1 being your most preferred assignment. You will be assigned to two areas for the entire summer. Every effort will be made to accommodate your top choices; however, assignments may be limited due to your availability and the needs of our facilities.

___ Clerical areas ? assist various hospital departments with such tasks as filing, collating, labeling and data entry.

___ Gift shops ? assist volunteers and staff by greeting customers as they enter the shops, selling merchandise, operating cash register and answering phones.

___ Greeter program ? assist visitors in finding locations within the hospital or offsite facilities.

___ Cheers on wheels ? visit patients on seventh (orthopedics), eighth (palliative care) and ninth (oncology) floors, offering movies, games, books, and audiocassettes for enjoyment.

___ Patient aide ? assist nursing staff and patients in a non-medical capacity on various nursing units.

___ Transportation ? transport discharged patients to the discharge area; also transport newly admitted patients to their rooms.

___ Novant Health Today's Child Learning Center ? assist staff with activities such as reading, tutoring, assisting with arts and crafts, feeding children and accompanying field trips.

Please check the days of the week that you are available to volunteer:

__ Monday

__ Tuesday

__ Wednesday

__ Thursday

__ Friday

__Saturday

Please check the hours that you prefer to volunteer:

__ 8:30 to 11:30 a.m. __ 12:00 to 3 p.m.

__ 3 to 6 p.m.

__ 8:30 a.m. to 3 p.m. __ 12 to 6 p.m.

(Two days per week) (Two days per week) (Two days per week) (One day per week,

(One day

with lunch/travel break) per week)

We have junior volunteer assignments on the Novant Health Forsyth Medical Center campus as well as at various offsite locations. Please check A or B for your preference for working on- or off-campus:

__ A. I am able to work at assignments away from the NHFMC campus and can provide my own transportation to those assignments. If you choose this option, please check any of the areas below that apply.

__ Clemmons/Lewisville __ Frontis Plaza area

__ Mocksville

__ Novant Health Winston-Salem

Health Care (Charlois Blvd.)

__ Downtown W-S __ North Point area

__ Kernersville __ Greensboro

__ I can do both of my assignments off-campus.

__ I only want one assignment to be off-campus.

__ B. I prefer to only be scheduled at assignments that are on the NHFMC campus, including Novant Health Medical Park Hospital, Novant Health Hawthorne Outpatient Surgery and Novant Health Today's Child Learning Center.

Vacation dates (including camps): ______________________________________________________________________ Note: You need to work at least six weeks during the summer program, 6/20/16 to 8/13/16.

jv service areas 2016

Novant Health Forsyth Medical Center Junior volunteer program

Essay

Please write a short essay explaining why you are interested in participating in the junior volunteer program at Novant Health Forsyth Medical Center. You should not be concerned with a right or wrong answer. Include interests and activities that you are involved with now as well as your long-term plans for the future. Finally, please let us know what you expect to gain from your volunteer experience at the hospital.

jv essay 2016

Novant Health Forsyth Medical Center Junior volunteer program

Recommendation form

To the applicant: Fill out the top portion of this form and take it to a teacher whom you have asked to recommend you for the program. Give your teacher at least two days to fill out the form and ask him or her to put it in a sealed envelope with the teacher's signature across the seal when finished. Pick up the envelopes from your teachers and return them to the volunteer office with the rest of your forms by the specified deadline.

Student's name: _______________________________________________________________

Student's school: ___________________________________________________ Grade: _____ I give you permission to release the following confidential information to Novant Health Forsyth Medical Center volunteer services.

Student's signature _____________________________________

To the teacher: Please answer the following questions regarding the above named student. This student is applying to the junior volunteer program at Novant Health Forsyth Medical Center. Your insight into his or her level of responsibility and dependability as well as his or her maturity is greatly appreciated. Any additional comments that would help me to learn more about this student are welcome.

Teacher's name: _______________________________________________________________

Subject: ____________________________ Contact number at school: ___________________

How long have you known this student? _____________________________________________

Can you depend on this student to complete assigned tasks?

yes ___

no ___

Does this student act mature around both adult and peer groups?

yes ___

no ___

Do you feel this student will fulfill a summer-long commitment?

yes ___

no ___

Please comment on any outstanding qualities that you feel would make this student an exceptional hospital volunteer: ____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

I highly recommend ___ recommend ___ do not recommend ___ (Please check one) this student for a position with the Novant Health Forsyth Medical Center junior volunteer program.

_________________________________________________ Teacher's signature

_______________________ Date

For more information please call 718-5729 Denise Brookie, coordinator of volunteer programs

jv recommendation form 2016

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download