Dear Prospective Teen Volunteer:

Thank you for your interest in volunteering at Duncan Regional Hospital. The program is available to students aged 15 or over who will be a sophomore or higher next fall. A completed application must be submitted for consideration. Limited spaces are available and are filled on a first-come-first-served basis. Returning teen volunteers at DRH receive first priority.

We ask that you serve a minimum of 6 hours per week if possible. This could be done in one day or in two separate days. It is our goal to place students in areas of interest (which should be noted in your essay).  We will schedule around your summer schedule the best we can.

Attending an orientation session is mandatory for participation. Students are required to bring one parent or guardian with them to orientation if they are under 18 years of age. You will receive orientation information if accepted into the program.

Teen volunteers are required to take a tuberculosis test, which we will provide prior to you beginning your volunteer service. (It is a simple test done in our Human Resources office.) If for any reason you have already had a TB test in the past year, documentation will be needed to avoid another test. Teens will also be required to submit their vaccination records if accepted to the program.

Teens will have an official polo shirt to wear, which can be purchased at orientation for $20.00 – your size is requested on the application form.  Long (full-length) khaki pants and clean, white (or mostly white) tennis shoes are also part of the DRH Teen Volunteer uniform. Sorry, we do not allow leggings, jeggings, shorts, or capri pants. It is preferred that pants are professional in appearance. Thank you for understanding.

If you have any questions, please feel free to call Betty at (580) 251-8495 or email betty.beck@drhhealth.org. I look forward to meeting you!

Sincerely,

Betty J. Beck, DVS/CAVS

Director of Volunteer Services

Step 1 of 3

33%

Name

First Middle Last

Teen Cell Phone

Date

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country

Home Phone

Birthdate

MM slash DD slash YYYY

Age

Father's Name

First Last

Father's Occupation

Father's Work Phone

Father's Cell Phone

Mother's Name

First Last

Mother's Occupation

Mother's Work Phone

Mother's Cell Phone

Personal Physician

Physician Phone

Allergies

Emergency Contact

First Last

Daytime Phone

Relationship

School

GPA

Grade next year

Year Graduated High School

Organizations Currently Involved In

Hobbies

Special Talent/Languages

Physical Limitations

Because of the importance of Teen Volunteer assignments during the summer, please list times you will have to be off (summer school, family vacations, etc.)

It is most important to be neat and clean at all times.

Are you willing to accept criticism?

Yes

No

Are you willing to accept supervision?

Yes

No

Does it bother you to be around ill people?

Yes

No

Days available to work

Monday

Tuesday

Wednesday

Thursday

Friday

Select All

Please list the best times to work

Prefers only office work?

Yes

No

Shirt Size

Shirt will be a cost of $20.00

Please indicate why you would like to volunteer at DRH Health. If you have a specific career goal in mind, please include that in your response.

I promise to abide by the rules and regulations of the Teen Volunteer Program as set forth by the Department of Volunteer Services. Teen Volunteer Signature Needed:(Required)

Date

MM slash DD slash YYYY

Parent's Signature Needed

Only if student is under 18

CAPTCHA