First Name * Last Name * Preferred Name * Address Line 1 * Address Line 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Code * Home Phone Number * Mobile Phone Number Email Address * Parent's Email Address *

Demographic Information

Please provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of Birth * Other than English, what other languages do you speak fluently? School *

Parent Contact

Please enter a parent contact in case of emergency.

Name * Phone Number * Relationship *

THC Association

Please list the name, relation and department of any relatives employed by Texas Health Cleburne.

Interests and Abilities

Please detail your previous volunteer experience, leadership/awards/honors, clubs/organization involvement and work experience.

Volunteer Essay

Please use the space below to complete the volunteer essay. Only applications with completed essays will be considered. This is an important part of your application and each one will be read carefully.

Please write an essay regarding why you wish to volunteer for Texas Health Cleburne including how volunteering relates to your future career goals, why you believe volunteering is important, what skills you possess that will make you a successful volunteer and what you hope to gain or learn. By checking the box below, I understand I am submitting an application to the High School Student Service Learning Volunteer Program & must meet the following requirements:

• Students must volunteer a minimum of 8 hours per week during summer business hours Monday-Friday, 8 a.m. - 4 p.m.
• Students must volunteer a minimum of 8 weeks and provide a minimum of 64 hours of service during the summer to participate.
• Summer vacation will not exceed two continuous weeks. Only 4 shifts may be made up.
• Volunteers are placed in both patient and non-patient areas. No particular assignment is guaranteed. Students will be placed by the volunteer office based on availability, experience and skills.
• All new volunteers will be required to purchase a uniform (green polo) from the volunteer office for $20.
• All onboarding volunteers will be required to undergo a background check.
• All selected volunteers must complete a Health screening which includes TB test, immunization history and drug testing prior to orientation.
• All selected Student Service Learning candidates must attend orientation on June 5.
• Students must participate in an interview as part of the selection criteria. A limited number of students will be chosen.
• Essays are required at the time of application.
• Two references are required as part of the interview process for new applicants.
• All applicants must have a valid Social Security Number.
• All selected students must have completed a COVID vaccine.