Welcome to NewYork Presbyterian Queens Volunteer Services.

NYPQ

Volunteer Application Form
Your application will not be considered if any of the sections are left left blank.
Personal Information
Application date
First name
Family/last name
Address
Apt#
City
State
Zip/postal
Cell Phone No.
Home Telephone No.
WorkTelehone No.
E-mail address
Emergency Contact Person
Relationship
Home Telephone No.
Cell Phone No.
Work Telephone No.
Demographic information
Currently employed
Currently employed
DOB (MM/DD/YYYY)
Gender
Highest Level of Education
Completed Degree/Subject
Current School/Institution enter N/A if not in school
Expected graduation date
Major/Concentration
Parents and other Famliy members will not be accepted as a Charater Reference
Character Reference
Name of Character Reference
E-mail address
Phone Number
Relationship to Applicant
Name of Organization
*PARENTS /FAMILY MEMBERS ARE NOT ACCEPTABLE CHARACTER REFERENCES
Assignment Preference
The list of assignments is posted to our website. It is important to refer back to the descriptions on our website
Assignment Preference:
Job preferences (as checklist)
Availability
Sunday
8am - 12pm
12pm - 4pm
4pm - 8pm
After 5pm
Monday
8am - 12pm
12pm - 4pm
4pm - 8pm
After 5pm
Tuesday
8am - 12pm
12pm - 4pm
4pm - 8pm
After 5pm
Wednesday
8am - 12pm
12pm - 4pm
4pm - 8pm
After 5pm
Thursday
8am - 12pm
12pm - 4pm
4pm - 8pm
After 5pm
Friday
8am - 12pm
12pm - 4pm
4pm - 8pm
After 5pm
Saturday
8am - 12pm
12pm - 4pm
4pm - 8pm
After 5pm
Bi-lingual Skills
Please indicate other languages in which you are fluent
Additional languages
Employment
Are you currently working? If so, please indicate your schedule
About You - Question 1
Why would you like to volunteer at New York- Presbyterian Queens?
About You - Question 2
List and explain any volunteer experience you've had in a hospital or other settings.
About You - Question 3
What do you hope to gain by participating in this program?
If you are applying for internship for school credit, please list the coordinator and number of hours required.
I can committ to 10 months or more to NYP Queens Volunteer Services
Who referred you to us?
How did you hear about our program?
If Online, please explain:
Agreement
I understand and agree that submitting this application form does not automatically register me as a New York- Presbyterian Queens Volunteer.
I am aware there may be certain qualification I must meet, including orientation, medical clearance, background check and a 10 month commitment.
By submitting this form, I attest that the information I have provided on this form is true, accurate, and NOT provided by a third party.
I Agree