Burke Hospice VolunTEEN Application

Burke Hospice is seeking teenagers between the ages of 14-18 to help fulfill our mission. We offer flexible hours in a variety of tasks. Please fill in the information below to indicate how you would like to become involved. For more information on teen volunteering projects, contact our Volunteer Coordinator, Merri Rudisill, at 828/879-1601 during business hours or email volunteer@burkehospice.org.

First Name *

Last Name *

Birthdate (MM/DD/YY): *

Address 1 *

Address 2

City *

State *

Postal Code *

Primary Phone *

Mobile/Other Phone *

Email Address

School You Attend *

Parent or Guardian's Name *

Parent or Guardian's Phone Number *

Emergency Contact (if different from above)

Relationship

Emergency Contact Phone Number

Have you previously done volunteer work for this organization? *

Yes

No

Have you experienced the death of a loved one within the last year? *

Yes

No

If yes, please explain:

Paid Employment & Volunteer Experience

Please list information for your last two positions. If you have not had two positions, please type "None" in each box.

	Company	Position	Dates
Position 1	Company	Position	Dates
Position 2	Company	Position	Dates

Volunteer Experience - Please list two that have been the most meaningful to you.

	Organization	Position	Dates
Position 1	Organization	Position	Dates
Position 2	Organization	Position	Dates

What areas of work would you be interested in (check all that apply)? *

Which days are you most available to volunteer? *

What times would you prefer to volunteer? *

Mornings

Afternoons

Evenings

Comments on Scheduling

Please list any clubs or groups to which you belong.

Please list any special interests, hobbies, or foreign language skills below.

Additional Comments/Info for our Volunteer Department:

By clicking the SUBMIT button below, I certify that my information on this form is correct to the best of my knowledge.