2017 Student Volunteer Program - Application

General Information

(include city, state and zip)
Cell Phone:
Is texting ok? Yes | No
Alternate Phone:
Email address:

School Information

Are you in high school or college? High School | College
Name of High School or College:
Current year in school:
Is there any type of work which your health or physical condition prohibits - or have you ever been advised by a physician to not perform certain types of work or recreation? If yes, please explain:
Please list number of missed days and reason for absences from school during the past two years.
What are your hobbies, interests and skills?
Why are you interested in becoming a Student Volunteer at SRHC?
Are there dates you will not be able to volunteer (camp, vacation, etc.)? If yes, please list.
In general, which days of the week and times of day (am, pm, evening) would you be available to volunteer?
What transportation is available to you?
Attendance at Student Volunteer Orientation is required.
I will attend the Tuesday, May 30 Orientation from 9am to Noon.
I will attend the Monday, June 5 Orientation from 1 to 4pm.
If unable to attend either orientation, please apply another year.


We require two character/performance references using the form found here.

*For complete guidelines, click here

* Bring sealed references with you to your interview