Volunteer Application (non-research)
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PERSONAL INFORMATION
*
First
Middle
*
Last
Preferred Name
*
Address
Apt. #
*
City/Town
State
AB
AK
AL
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
*
Zip
*
Cell Phone Number
Home Phone Number
Preferred phone type
Home
Cell
Gender
Female
Male
Not disclosed
Please indicate your preferred pronoun(s):
Age: (all Mount Sinai applicants must be at least 15 years old)
15
16-17
18+
*
Date of Birth
Have you ever been suspended or discharged by an employer for incidence of physical or verbal abuse of a patient, co-worker, customer or visitor?
Yes
No
*
If yes, please explain.
Are you currently a U.S. Citizen or Green Card holder?
Yes
No
If yes, which one?
U.S. Citizen
Green Card holder
If you are neither a U.S. Citizen nor Green Card holder, you will need clearance from the Mount Sinai International Personnel (IP) Department prior to being placed as a volunteer.
If you are an International Applicant, please fill out:
*
Name of Department Administrator
*
Name of Supervisor
*
Location of Internship
*
Volunteer Assignment Start Date
*
Volunteer Assignment End Date
CPT Approved?
Yes
No
Uploading...
Please note for foreign nationals only, upload your proof of CPT.
remove
EDUCATION
High School
Are you a current high school student?
No
Yes
*
School Name
*
School Address
Current Year of Applicant:
Freshman
Sophomore
Junior
Senior
*
Name of School Advisor or Counselor
*
Title
*
Email
College/University
Please indicate highest level degree.
Name of School:
School Address:
Major:
Type of Degree:
Degree status:
Degree completed
Degree in progress
Additional Education
School
Certification/License/Degree:
RESUME
Uploading...
*
Please upload a copy of your resume.
remove
EMERGENCY CONTACT
*
IN CASE OF EMERGENCY, WHOM SHOULD WE CONTACT? Name:
*
Relationship:
*
Phone:
CONNECTIONS TO MOUNT SINAI
*
How did you learn about our Department of Volunteer Services? Please check all that apply.
Friend
Internet search
Mount Sinai Referral
Other
Reputation
School
If other, please specify
Have you ever volunteered at the Mount Sinai Health System?
Yes
No
*
If yes, dates:
Mount Sinai Health System Site:
Mount Sinai Downtown-Beth Israel
Mount Sinai Downtown-Chelsea Center
Mount Sinai-New York Eye and Ear Infirmary
Mount Sinai-Stuyvesant Town
Mount Sinai Downtown-Union Square
Mount Sinai Health Partners
Mount Sinai Hospital
Mount Sinai St. Luke's
Mount Sinai Queens
Mount Sinai West
Icahn School of Medicine
*
Program/Department
*
Supervisor
Are you a current or previous employee of Mount Sinai Health System?
Yes
No
Are you a current,previous employee or retired?
Previous employee
Retired
Current employee
MSHS Site
Mount Sinai Downtown-Beth Israel
Mount Sinai Downtown-Chelsea Center
Mount Sinai-New York Eye and Ear Infirmary
Mount Sinai-Stuyvesant Town
Mount Sinai Downtown-Union Square
Mount Sinai Health Partners
Mount Sinai Hospital
Mount Sinai Morningside (previously St. Luke's)
Mount Sinai Queens
Mount Sinai West
Icahn School of Medicine
Mount Sinai Brooklyn
Mount Sinai Corporate (42nd Street)
Mount Sinai South Nassau
Mount Sinai Doctors
Department
Addiction Institute of Mount Sinai
Arnhold Institute for Global Health
BioMedical Engineering and Imaging Institute
Conduits - The Institutes for Translational Sciences
Department of Anesthesiology Perioperative and Pain Medicine
Department of Cardiovascular Surgery
Department of Cell Developmental and Regenerative Biology
Department of Dentistry
Department of Dermatology
Department of Diagnostic Molecular and Interventional Radiology
Department of Emergency Medicine
Department of Emergency Medicine - Disaster and Emergency Preparedness Division
Department of Emergency Medicine - Emergency Ultrasound Division
Department of Emergency Medicine - Geriatric Emergency Medicine and Palliative Care Division
Department of Emergency Medicine - Global Health Division
Department of Emergency Medicine - Informatics Division
Department of Emergency Medicine - Pediatric Emergency Medicine Division
Department of Emergency Medicine - Research Division
Department of Emergency Medicine - Simulation Division
Department of Emergency Medicine - Toxicology Division
Department of Environmental Medicine and Public Health
Department of Family Medicine and Community Health
Department of Family Medicine and Community Health - Integrative Medicine Program
Department of Genetics and Genomic Sciences
Department of Geriatrics and Palliative Medicine
Department of Health System Design and Global Health
Department of Medical Education
Department of Medicine
Department of Medicine - Division of Cardiology
Department of Medicine - Division of Clinical Immunology
Department of Medicine - Division of Endocrinology Diabetes and Bone Disease
Department of Medicine - Division of Gastroenterology
Department of Medicine - Division of General Internal Medicine
Department of Medicine - Division of Genomic Medicine
Department of Medicine - Division of Hematology and Medical Oncology
Department of Medicine - Division of Hospital Medicine
Department of Medicine - Division of Infectious Diseases
Department of Medicine - Division of Liver Diseases
Department of Medicine - Division of Nephrology
Department of Medicine - Division of Pulmonary Critical Care and Sleep Medicine
Department of Medicine - Division of Rheumatology
Department of Microbiology
Department of Neurology
Department of Neurology - Division of Cognitive Disorders
Department of Neurology - Division of General Neurology
Department of Neurology - Division of Headache and Facial Pain
Department of Neurology - Division of Movement Disorders
Department of Neurology - Division of Neuro-Infectious Diseases
Department of Neurology - Division of Neuromuscular Disease
Department of Neurology - Division of Neuro-Oncology
Department of Neurology - Division of Neuro-Ophthalmology
Department of Neurology - Division of Neuro-Otology and Neurogenetics
Department of Neurology - Division of Pediatric Neurology
Department of Neurology - Division of Stroke - Cerebrovascular Disorders
Department of Neurology - Epilepsy Program
Department of Neurology - The Corinne Goldsmith Dickinson Center for Multiple Sclerosis
Department of Neuroscience
Department of Neurosurgery
Department of Obstetrics Gynecology and Reproductive Science
Department of Obstetrics Gynecology and Reproductive Science - Division of Family Planning
Department of Obstetrics Gynecology and Reproductive Science - Division of Global Womens Health
Department of Obstetrics Gynecology and Reproductive Science - Division of Gynecologic Cancer
Department of Obstetrics Gynecology and Reproductive Science - Division of Maternal Fetal Medicine - High-Risk Pregnancy
Department of Obstetrics Gynecology and Reproductive Science - Division of Midwifery
Department of Obstetrics Gynecology and Reproductive Science - Division of Obstetrics Gynecology and Reproductive Science
Department of Obstetrics Gynecology and Reproductive Science - Division of Pregnancy and Birth Services
Department of Obstetrics Gynecology and Reproductive Science - Division of Reproductive Endocrinology and Infertility
Department of Obstetrics Gynecology and Reproductive Science - Division of Sexually Transmitted and Infectious Diseases
Department of Oncological Sciences
Department of Ophthalmology
Department of Orthopaedics
Department of Otolaryngology-Head and Neck Surgery
Department of Pathology Molecular and Cell-Based Medicine
Department of Pediatrics
Department of Pediatrics - Adolescent Health Center
Department of Pediatrics - Alice Gottesman Bayer Pediatric Intensive Care Unit
Department of Pediatrics - Division of Allergy and Immunology
Department of Pediatrics - Division of Developmental Pediatrics
Department of Pediatrics - Division of Endocrinology and Diabetes
Department of Pediatrics - Division of Gastroenterology
Department of Pediatrics - Division of General Pediatrics
Department of Pediatrics - Division of Hematology-Oncology
Department of Pediatrics - Division of Infectious Diseases
Department of Pediatrics - Division of Kidney Disease
Department of Pediatrics - Division of Neurology
Department of Pediatrics - Division of Pulmonology
Department of Pediatrics - Division of Rheumatology
Department of Pediatrics - Kravis Childrens Heart Center
Department of Pediatrics - Neonatal Intensive Care Unit
Department of Pharmacological Sciences
Department of Population Health Science and Policy
Department of Psychiatry
Department of Psychiatry - Division of Clinical Services
Department of Radiation Oncology
Department of Rehabilitation and Human Performance
Department of Social Work
Department of Surgery
Department of Thoracic Surgery
Department of Urology
Ear Institute
Eye and Vision Research Institute
Icahn Institute for Data Science and Genomic Technology
Institute for Care Innovations at Home
Institute for Exposomic Research
Institute for Health Care Delivery Science
Institute for Liver Medicine
Institute for Medical Education
Institute for Next Generation Healthcare
Institute for Transformative Clinical Trials
Mount Sinai -- National Jewish Health Respiratory Institute
Mount Sinai Diabetes Obesity and Metabolism Institute
Mount Sinai Drug Discovery Institute
Mount Sinai Global Health and Emerging Pathogens Institute
Mount Sinai Head and Neck Institute
Mount Sinai Institute for Advanced Medicine
Mount Sinai Institute for Critical Care Medicine
Mount Sinai Institute for Systems Biomedicine
Mount Sinai Institute for Translational Epidemiology
Mount Sinai Precision Immunology Institute
The Black Family Stem Cell Institute
The Blavatnik Family Womens Health Research Institute
The Charles Bronfman Institute for Personalized Medicine
The Clinical Diabetes Institute
The Elliot and Roslyn Jaffe Food Allergy Institute
The Friedman Brain Institute
The Hasso Plattner Institute for Digital Health at Mount Sinai
The Joseph F. Cullman Jr. Institute for Patient Experience
The Lilian and Benjamin Hertzberg Palliative Care Institute
The Mindich Child Health and Development Institute
The Mirken Family Clinical Neuroscience Institute
The Tisch Cancer Institute
Z - Other
Institute for Health Equity Reseach
Department of Volunteer Services
Materials Management
Department of Emergency Management
Department of Nursing
MSHS/Corporate HR
MSHS/IT
MSHS/Marketing
Office for Diversity and Inclusion (ODI)
Cardiovascular Research Institute
If Other, please describe
*
Position/Title
*
Supervisor
Are you a current or previous student of Icahn School of Medicine at Mount Sinai (ISMMS)?
Yes
No
Please indicate which, previous or current:
Current
Previous
If Sinai Student, Degree program
PhD in Biomedical Sciences
PhD in Clinical Research
PhD in Neuroscience
Master of Public Health
Master of Science in Clinical Research
Master of Science in Genetic Counseling
Master of Science in Biomedical Science
Master of Science in Biostatistics
Master of Science in Biomedical Data Science
Master of Science in Healthcare Delivery Leadership
Master of Health Administration
Clinical Research Training Program (Certificate)
Advanced Certificate in Public Health
Dual-Degree Program (Specify After)
Do you have any relatives employed by The Mount Sinai Health System?
Yes
No
If yes, please provide name of your relative and how they are connected to Mount Sinai.
MORE ABOUT YOU
Do you have a confirmed volunteer placement?
Yes
No
*
Name of Supervisor at Mount Sinai
*
Email of Supervisor at Mount Sinai
Are you affiliated with a Mount Sinai community partner organization?
Yes
No
Please select the Mount Sinai Community Partner.
STRIVE
MAPS Corps
1199
Sunrise on Wheels
Project Sunshine
Hole in the Wall Gang
Musicians On Call
Concerts in Motion
Salon de Virtuosi
Red Door Community (Formerly Gilda's Club)
Sickle Cell Thalassemia Patient Network (SCTPN)
*
Please select the Mount Sinai Health System site where you will be volunteering.
Icahn School of Medicine at Mount Sinai
Mount Sinai Beth Israel
Mount Sinai Brooklyn
Mount Sinai Doctors
Mount Sinai Downtown
Mount Sinai Morningside
Mount Sinai Queens
Mount Sinai South Nassau
Mount Sinai West
MSHS Corporate Office
New York Eye and Ear Infirmary of Mount Sinai
The Mount Sinai Hospital
Please select the length of volunteer assignment.
Episodic (one to five days)
Less than 6 Weeks
More than 6 Weeks to 1 Year
*
Will your volunteer experience be onsite, remote or hybrid? (Select below)
Onsite
Fully Remote
Hybrid
*
During your volunteer assignment, will you have access to Protected Health Information (PHI) and/or electronic access to Mount Sinai systems?
With PHI or Electronic Access
No PHI or Electronic Access
What program or department are you most interested in? (First Choice)
1199 Program
AbleGamers/QuadGods
Administrative Support
Adolescent Health Center (AHC) Tutor
Ambassador Program
Ambulatory Faculty Practice
Art for Healing
At the Ready!/Float Pool
Auxiliary Board Members
CARE ED
CARE Inpatient
CARE Tech
Child Life
Cristo Rey New York High School Work Study Program
Dubin Breast Center
Dubin Breast Center (Peer to Peer)
Greeter - Hospital Lobby
Greeter - Operating Room Waiting Area
Hospital Delirium Program
ISMMS Chemo Companions
ISMMS Music and Medicine
ISMMS Trans Buddy Program
Junior Medical Program (JuMP)
KidZoneTV
Language Assistance Program (LAP)
Language Services
MAPSCorps
Meal Assistance Program
Mount Sinai CALM - Yoga Instructor
Mount Sinai CALM Virtual Tutoring Program
Music for Healing
Nursing Pathway Program
Office for Diversity and Inclusion (ODI) - CEYE
Office for Diversity and Inclusion (ODI) - CHSA
Office for Diversity and Inclusion (ODI) - NERA
Ophthalmology and Otolaryngology
Palliative Care Doula Program
Parent Sharing
Patient and Family Advisory Committee (PFAC)
Patient Experience
Pet-Assisted Therapy (PAT)
Physical Therapy/Occupational Therapy (PT/OT)
Postpartum CARE (Care, Respect, and Equity)
Public Health and Racial Justice Program
Rainbow Clinic
Recanti Miller Transplant Institute (RMTI)
Ruttenberg Treatment Center (RTC)
SPEEK
Spiritual Care (Eucharistic Minister)
Spiritual Care (General)
Take 10 (TM)
Tisch Cancer Center - Oncology Navigator Program
Tisch Cancer Institute (TCI) - COE Outreach Team
Unit Support
Woman-to-Woman
Z-Other
What program or department are you most interested in? (Second Choice)
Administrative Support
Adolescent Health Center (AHC) Tutor - preapproval required
Ambassador
Art for Healing
CARE - ED
CARE - Inpatient/Mobility
CARE - Tech
Chi Time (TM)
Child Life
Conversation Partners - preapproval required
Hospital Delirium Program
Department of Education (DOE) - preapproval required
Doula Program
Dubin Breast Center
ISMMS Chemo Companions - preapproval required
ISMMS Music at the Bedside - preapproval required
JOP - preapproval required
Language Assistance Program (LAP) - preapproval required
MAPSCorps - preapproval required
MSHP (Mount Sinai Health Partners)
Music for Healing
Pet-Assisted Therapy (PAT)
PFPP (Patient & Family Partner Program) - preapproval required
Physical Therapy/Occupational Therapy (PT/OT) - preapproval required
Project Teen HEED - preapproval required
RMTI (Recanti Miller Transplant Institute)
Ruttenberg Treatment Center (RTC)
SAVI
SPEEK - preapproval required
Spiritual Care - General
Spiritual Care - Eucharistic Minister
Teen Ambassador
Teen Rehabilitation Therapy (HS Rehab Program)
Woman-to-Woman - preapproval required
Other
Reach Out and Read (ROaR) - Child Life (63)
Teen Child Life (93)
What program or department are you most interested in? (Third Choice)
Administrative Support
Adolescent Health Center (AHC) Tutor - preapproval required
Ambassador
Art for Healing
CARE - ED
CARE - Inpatient/Mobility
CARE - Tech
Chi Time (TM)
Child Life
Conversation Partners - preapproval required
Hospital Delirium Program
Department of Education (DOE) - preapproval required
Doula Program
Dubin Breast Center
ISMMS Chemo Companions - preapproval required
ISMMS Music at the Bedside - preapproval required
JOP - preapproval required
Language Assistance Program (LAP) - preapproval required
MAPSCorps - preapproval required
MSHP (Mount Sinai Health Partners)
Music for Healing
Pet-Assisted Therapy (PAT)
PFPP (Patient & Family Partner Program) - preapproval required
Physical Therapy/Occupational Therapy (PT/OT) - preapproval required
Project Teen HEED - preapproval required
RMTI (Recanti Miller Transplant Institute)
Ruttenberg Treatment Center (RTC)
SAVI
SPEEK - preapproval required
Spiritual Care - General
Spiritual Care - Eucharistic Minister
Teen Ambassador
Teen Rehabilitation Therapy (HS Rehab Program)
Woman-to-Woman - preapproval required
Other
Reach Out and Read (ROaR) - Child Life (59)
Teen Child Life (108)
*
Please indicate any preferences for patient populations (geriatric, oncology, etc.):
What is your native language?
Afrikaans
Akan
Aklanon
Albanian
Aleut
Algerian
Amharic
Anishinaabemowin
Arabic
Aramic
Arawakan
Armenian
ASL
Avestan
Ayapathu
Aymara
Azeri
Bamwe
Bantu
Basa
Basque
Belarusan
Bemba
Bengali
Berber
Bicol
Bisaya
Bobangi
Bosnian
Brahui
Breton
Bukusu
Bulgarian
Burmese
Butuanon
Byelorussian
Cambodian
Cantonese
Catalan
Cayuga
Cebuano
Ch'ol
Chaldean
Chamorro
Chechen
Chewa
Chinese
Chinook
Chorti
Coptic
Cree
Creole
Croatian
Czech
Danish
Dari
Demonh'ka
Dinka
Dothraki
Dutch
Ebu
Eggon
Egyptian
Emakua
English
Eskimo
Estonian
Etruscan
Fang
Faroese
Farsi
Filipino
Finnish
Flemish
Frankish
French
Fujanese
Fuzhounese
Gaelic
Gaelic (Irish)
Gaelic (Scottish)
Gaelic (Welsh)
Galician
Gamilaraay
Ganda
Gaulish
Gbari
Georgian
German
Gevove
Gilbertese
Gothic
Greek
Guarani
Gujarati
Guyanese Creole patois
Haida
Haitian Creole
Hakka
Halaka
Hausa
Hawaiian
Hebrew
Hiligaynon
Hindi
Hmong
Hokkien
Hungarian
Icelandic
Igbo
Ilocano
Ilonggo
Indonesian
Ingush
Inuit
Inupiat
Italian
Japanese
Jita
Kachi
Kakwa
Kalanga
Kannada
Kapampangan
Kapampangan
Karelian
Kashmiri
Katcha
Kazakh
Kerewe
Khmer
Khowar
Kiga
Klallam
Klingon
Kongo
Konkani
Korean
Koyo
Kurdish
Lakhota
Laotian
Latin
Latvian
Lebanese
Lingala
Lithuanian
Lozi
Luganda
Luwian
Lycian
Lydian
Mabwe
Macedonian
Malay
Malayalam
Maliseet
Maltese
Mandarin
Mandinka
Manx
Maori
Mapudungun
Marathi
Masaba
Mawu
Mayan
Mayangna
Miami
Minbari
Miskitu
Mixtec
Mohawk
Mongolian
Mpongwe
Nahuatl
Nande
Nauruan
Navajo
Ndebele
Nepali
Nkwen
Norwegian
Nyamwezi
Occitan
Ojibwe
Olkola
Olutec
Onondaga
Oriya
Oromo
Oykangand
Pahlavi
Pakahn
Pali
Papiamento
Pashto
Pende
Persian
Phoenician
Phrygian
Pidgin
Piraha
Polish
Popoluca
Portuguese
Potawatomi
Prussian
Punjabi
Quechua
Rasta
Rejang
Romanian
Romany
Rotuman
Russian
Saanich
Samoan
Sanskrit
Seneca
Serbian
Seri
Shanghainese
Shi
Shona
Sicilian
Signing Exact English
Sindhi
Sinhala
Slovak
Slovene
Sogdian
Somali
Sorbian
Spanish
Sranan
Sudovian
Sumerian
Swabian
Swahili
Swedish
Tagalog
Taishanese
Taiwanese
Tajik
Tamazight
Tamil
Tarahumara
Tarok
Tatar
Telugu
Teochew
Thai
Thracian
Tibetan
Tigrinya
Tlingit
Tocharian
Tongan
Treu Chau
Turkish
Turkmen
Twi
Ukrainian
Ulwa
Umbrian
Urdu
Uyghur
Uzbek
Venda
Veps
Vietnamese
Visayan
Votic
Warlpiri
Welsh
Wolof
Xhosa
Yaka
Yao
Yemba
Yiddish
Yoruba
Yupik
Zoque
Zulu
Do you speak any additional languages?
Yes
No
If so, which language(s)?
Afrikaans
Akan
Aklanon
Albanian
Aleut
Algerian
Amharic
Anishinaabemowin
Arabic
Aramic
Arawakan
Armenian
ASL
Avestan
Ayapathu
Aymara
Azeri
Bamwe
Bantu
Basa
Basque
Belarusan
Bemba
Bengali
Berber
Bicol
Bisaya
Bobangi
Bosnian
Brahui
Breton
Bukusu
Bulgarian
Burmese
Butuanon
Byelorussian
Cambodian
Cantonese
Catalan
Cayuga
Cebuano
Ch'ol
Chaldean
Chamorro
Chechen
Chewa
Chinese
Chinook
Chorti
Coptic
Cree
Creole
Croatian
Czech
Danish
Dari
Demonh'ka
Dinka
Dothraki
Dutch
Ebu
Eggon
Egyptian
Emakua
English
Eskimo
Estonian
Etruscan
Fang
Faroese
Farsi
Filipino
Finnish
Flemish
Frankish
French
Fujanese
Fuzhounese
Gaelic
Gaelic (Irish)
Gaelic (Scottish)
Gaelic (Welsh)
Galician
Gamilaraay
Ganda
Gaulish
Gbari
Georgian
German
Gevove
Gilbertese
Gothic
Greek
Guarani
Gujarati
Guyanese Creole patois
Haida
Haitian Creole
Hakka
Halaka
Hausa
Hawaiian
Hebrew
Hiligaynon
Hindi
Hmong
Hokkien
Hungarian
Icelandic
Igbo
Ilocano
Ilonggo
Indonesian
Ingush
Inuit
Inupiat
Italian
Japanese
Jita
Kachi
Kakwa
Kalanga
Kannada
Kapampangan
Kapampangan
Karelian
Kashmiri
Katcha
Kazakh
Kerewe
Khmer
Khowar
Kiga
Klallam
Klingon
Kongo
Konkani
Korean
Koyo
Kurdish
Lakhota
Laotian
Latin
Latvian
Lebanese
Lingala
Lithuanian
Lozi
Luganda
Luwian
Lycian
Lydian
Mabwe
Macedonian
Malay
Malayalam
Maliseet
Maltese
Mandarin
Mandinka
Manx
Maori
Mapudungun
Marathi
Masaba
Mawu
Mayan
Mayangna
Miami
Minbari
Miskitu
Mixtec
Mohawk
Mongolian
Mpongwe
Nahuatl
Nande
Nauruan
Navajo
Ndebele
Nepali
Nkwen
Norwegian
Nyamwezi
Occitan
Ojibwe
Olkola
Olutec
Onondaga
Oriya
Oromo
Oykangand
Pahlavi
Pakahn
Pali
Papiamento
Pashto
Pende
Persian
Phoenician
Phrygian
Pidgin
Piraha
Polish
Popoluca
Portuguese
Potawatomi
Prussian
Punjabi
Quechua
Rasta
Rejang
Romanian
Romany
Rotuman
Russian
Saanich
Samoan
Sanskrit
Seneca
Serbian
Seri
Shanghainese
Shi
Shona
Sicilian
Signing Exact English
Sindhi
Sinhala
Slovak
Slovene
Sogdian
Somali
Sorbian
Spanish
Sranan
Sudovian
Sumerian
Swabian
Swahili
Swedish
Tagalog
Taishanese
Taiwanese
Tajik
Tamazight
Tamil
Tarahumara
Tarok
Tatar
Telugu
Teochew
Thai
Thracian
Tibetan
Tigrinya
Tlingit
Tocharian
Tongan
Treu Chau
Turkish
Turkmen
Twi
Ukrainian
Ulwa
Umbrian
Urdu
Uyghur
Uzbek
Venda
Veps
Vietnamese
Visayan
Votic
Warlpiri
Welsh
Wolof
Xhosa
Yaka
Yao
Yemba
Yiddish
Yoruba
Yupik
Zoque
Zulu
Have you participated in any youth education and pipeline programs sponsored by the Icahn School of Medicine at Mount Sinai (ISMMS)?
Yes
No
*
Which program(s) have you participated in?
Center for Excellence in Youth Education (CEYE)
First Generation Scholars Program
MedDOCS Program for High School Students
MedStart Summer Enrichment Program for Middle School Students
Mentoring in Neuroscience (MiNDS)
Post-Baccalaureate Research Education Program (PREP)
Summer Undergraduate Research Program (SURP)
Are you a current or previous participant?
Current
Previous
OTHER SPECIAL SKILLS OR QUALIFICIATIONS
Skills
Administration/Office
Artist
Audio/Visual
Child Care
Companionship
Compassion
Computer - Data entry
Computer - IT general
Construction - Carpentry
Construction - Electrical
Construction - General
Construction - Painting
Construction - Plumbing
Custodial
Event Planning
Food Services - Delivery
Food Services - Preparation
Fundraising
Gardening
Grant Writing
Graphic Design
Language/Translator
Law Enforcement
Legal
Library
Listening
Marketing/Communications
Medical - Doctor/Physician
Medical - First Aid
Medical - General
Medical - Nursing
Musician
Photography
Political/Government
Public Relations
Public Speaking
Sales/Cashier
Sports - Coaching
Sports - Official
Transportation - Driver (bus/van)
Transportation - Driver (car)
Transportation - Emergency
Transportation - Moving
Transportation - Parking
Video Production
Writing/Reporting
*
What motivates you to want to volunteer at this point in your life? Please indicate whether you have an interest in any particular program or patient population and share why.
*
What skills and strengths would you bring to your volunteer service? Please share how these might impact your service and those you serve with.
*
How might volunteering impact your career or professional goals?
*
What experiences do you have related to where you want to volunteer?
*
Please list all of the time commitments/extracurricular activities you will have outside of class during the time period you wish to volunteer.
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What days/times you are available to volunteer? Please be specific. Minimum of four consecutive hours per week. Please note that a majority of our opportunities are on Mondays through Fridays from 9 am to 5 pm.
REFERENCES
Reference #1
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Reference #1 name:
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Title
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Organization
Relationship
Employer
Professional
Teacher/Professor
*
E-mail
Reference #2
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Reference #2 name:
*
Title
*
Organization
Relationship
Employer
Professional
Teacher/Professor
*
E-mail
Reference #3
Reference #3 name:
Organization
Title
Relationship
Employer
Professional
Teacher/Professor
E-mail
AGREEMENT
I understand and agree that:
I certify that the information contained in this application is correct to the best of my knowledge. I authorize investigation of all matters contained in this application and agree that any misleading or false statements could be cause for rejection of this application or would be sufficient cause for dismissal from a volunteer placement at the Mount Sinai Hospital. I understand that my volunteer placement is contingent upon satisfactory completion of a toxicology screening and a health screening by a Mount Sinai Employee Health Service practitioner or private physician, the receipt by Mount Sinai of a satisfactory reference and my satisfactory completion of the probation period. I hereby authorize my present/past employers to furnish Mount Sinai with my records of service.
If I am accepted as a volunteer, I authorize Mount Sinai Hospital to conduct any and all verifications as permitted by Federal, State and municipal codes and regulations. I agree to abide by all Mount Sinai rules and regulations. I agree to follow Mount Sinai policies with respect to a drug-free workplace and I affirm that I do not use un-prescribed controlled substances and/or any illegal substances. I understand that my volunteer service is not governed by any written or oral contract and is considered an "at will" arrangement. This means that I am free, as is Mount Sinai, to terminate the volunteer relationship for any or no reason, as long as there is no violation of applicable Federal, State or Local law.
I understand that the volunteer clearance process is highly selective and that the completion of the volunteer application does not guarantee a volunteer placement at Mount Sinai Health System. In consideration of any volunteer opportunity which may be offered to me, I agree to comply with the policies, rules, regulations and procedures of Mount Sinai. This application will remain current for 90 days. If I have not then been on boarded as a volunteer by Mount Sinai within this timeframe, I understand that I may need submit a new application to remain eligible for volunteer consideration.
My name below will stand as my signature, confirming the completeness and accuracy of the information I provided above, and will carry the same force and effect as if it were signed and affixed by my hand.
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clear
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Signature