NHCare Online Bill Pay Patient Portal Make or Cancel An Appointment Donate to Neighborhood Healthcare NHCare Arabic Brochure
NHCare Online Bill Pay Patient Portal Make or Cancel An Appointment Donate to Neighborhood Healthcare NHCare Arabic Brochure

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Application for Volunteer, Internship, or Clinical Rotation

Are you interested in a Volunteer, Intern, or Clinical Rotation position?*
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First Name*
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Last Name*
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Street Address *
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City*
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State*
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Zip*
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Phone Number*
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Email*
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Emergency Contact*
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Parent/Guardian, Spouse, etc.

Emergency Contact Phone Number*
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Education Background*

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Is this volunteer service required by school?*
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Are you a medical student?
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Which school are you a student at?
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If Other, which school or program are you affiliated with?
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If you are a licensed professional, what is the current status of your license?
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Unfortunately, Neighborhood Healthcare does not accept volunteers with a ‘restricted’ license. Thank you.
Do you have language skills other than English?
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If yes, can you speak fluently?
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Which languages can you read

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If other, what language(s) can you read?
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Which languages can you speak?

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If other, what language(s) can you speak?
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Which languages can you write?

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If other, what language(s) can you write?
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Name of person we should contact at school:
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Phone Number for school contact:
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Have you ever worked at Neighborhood Healthcare?*
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If Yes, in which department did you work?
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Have you ever volunteered at Neighborhood Healthcare?*
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If Yes, in which department did you volunteer?
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Are you currently, or have you ever been, a patient at Neighborhood Healthcare?*
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If yes, at which site were you a patient?

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Which Neighborhood Healthcare location(s) would you like to volunteer at?*

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What date are you available to start volunteering?*
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Availability
Mon

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Tues

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Wed

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Thurs

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Fri

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Sat

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Which department or program(s) would you like to volunteer with?*

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Please let us know what other department or program you would like to volunteer with.
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What would you like to gain from this experience?*
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How did you hear about Neighborhood Healthcare?*

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How did you hear about Neighborhood Healthcare?
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Did someone refer you for this volunteer/intern position?*
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If yes, what is their name? Please include their first and last name.
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Additional comments or notes
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