Date of Application:
Today D-M-Y
Previous Volunteer Application and / or Service Experience at a Cleveland Clinic Location:
Yes, I have applied and served as a volunteer at a Cleveland Clinic location Yes, I have applied but not served as a volunteer at a Cleveland Clinic location No, I have not applied or served as a volunteer at a Cleveland Clinic location I am a current Cleveland Clinic Volunteer at a Cleveland Clinic location
Cleveland Clinic location: Ohio, Florida, Nevada, Toronto, London
Preferred Name Prefix:
Hon. Sister Atty. Brother Chief Dean Dr. Father (Religious) Master Mr. Mrs. Ms. Rabbi Rev. Other
Applicant First Name:* must provide value
Please utilize legal name
Applicant Last Name:* must provide value
Preferred Name:
Examples: Mr. Harris, Adarsh, Dr. Jones, Ms. Zhao, Bob, Lilly
Preferred Name Suffix:
CPA DDS DO Elder Esq. II III IV JD Jr. LLD MD PhD Ret. RN Sr. USA US Army USA Ret. USAF US Air Force USAF Ret. USMC US Marine Corp. USMC US Marine Reserves USN US Navy USN Ret. Other
Please share "Other" Preferred / Suffix
My primary phone number is:* must provide value
Cell Phone Land Line (Home) Work
Primary ______ number:* must provide value
Example: 4402166986
My preferred phone number is:
Cell Phone Land Line (Home) Work Same
My preferred ______ number Is:
Example: 4402166986
Our primary mechanism of keeping volunteers informed is through email. * must provide value
Please add this email to your contact list, to avoid critical information going to your spam: volunteer@ccf.org
Country of Permanent Residence:* must provide value
United States of America Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo, Republic of the Congo, Democratic Republic of the Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor-Leste) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon The Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City (Holy See) Venezuela Vietnam Yemen Zambia Zimbabwe Other
Other Country:
Permanent Street Address:* must provide value
Permanent Address:
Permanent City of Residence:* must provide value
Permanent State of Residence:
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Maryland Massachusetts Michigan Minnesota Mississippi Missouri Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Permanent Territory of Residence:
Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Other
Other Territory:
Permanent Residence Zip Code:* must provide value
Highest grade or year of school completed:* must provide value
Under Grade 8 (No high school) Grades 9-11 (Some high school) Grade 12 or GED (High school graduate) College 1-3 years (Some college, tech school, or associate's degree) College 4 years or more (College graduate) Graduate or post-college professional degree Prefer not to answer
Cleveland Clinic volunteering requires volunteers to be at least 15 years of age. Primary Language Spoken In My Home:* must provide value
English Algerian Arabic American Sign Language Australian Sign Language Bavarian Bengali Bhojpuri Burmese British Sign Language Czech Dutch Eastern Punjabi Egyptian Arabic French Gan Chinese German Greek Gujarati Hakka Chinese Hausa Hejazi Arabic Hindi Igbo Indonesian Iranian Persian Italian Japanese Javanese Jin Chinese Kannada Korean Maithiki Malayalam Mandarin Chinese Marathi Min Nan chinese Morroccan Arabic Northern Uzbek Odia Polish Portugese Romanian Russion Sa'idi Arabic Sindhi Spanish Sudanese Arabic Sundra Swedish Tagalog Tamil Telugu Thai Turkish Ukrainian Urdu Vietnamese Western Punjabi Wu Chinese Xiang Chinese Yoruba Yue Chinese Zulu Other
Describe Other Language:
Second Language Spoken in my Home:
Algerian Arabic American Sign Language Australian Sign Language Bavarian Bengali Bhojpuri Burmese British Sign Language Czech Dutch Eastern Punjabi Egyptian Arabic English French Gan Chinese German Greek Gujarati Hakka Chinese Hausa Hejazi Arabic Hindi Igbo Indonesian Iranian Persian Italian Japanese Javanese Jin Chinese Kannada Korean Maithiki Malayalam Mandarin Chinese Marathi Min Nan chinese Morroccan Arabic Northern Uzbek Odia Polish Portugese Romanian Russion Sa'idi Arabic Sindhi Spanish Sudanese Arabic Sundra Swedish Tagalog Tamil Telugu Thai Turkish Ukrainian Urdu Vietnamese Western Punjabi Wu Chinese Xiang Chinese Yoruba Yue Chinese Zulu Other
Describe Other Language:
How would you describe your life's primary occupation based on the occupation categories listed below?
* must provide value
Architecture and Engineering Arts, Design, Entertainment, Sports, and Media Building, Grounds Cleaning, and Maintenance Business and Financial Operations Computer and Mathematical Construction and Extraction Education Instruction and Library Farming, Fishing, Forestry Food Preparation and Serving Healthcare Practitioners and Technical Healthcare Support Inside the Home Installation, Maintenance, and Repair Legal Life, Physical and Social Sciences Office and Administrative Support Personal Care and Service Production Protective Services Sales Transportation and Material Moving Other
If you are retired, please also check your primary occupation prior to retirement.
How might you describe your role with ______ ?
Examples include but are not limited to: Civil Engineer, Doctor, University Professor, Chief Executive Officer, Respiratory Therapist, Nurse, Stylist, Real Estate Agent
Please describe "Other" occupation category:
I am a current or former employee of Cleveland Clinic:* must provide value
Yes
No
Previous employment does NOT prevent you from volunteering.
Area of employment at Cleveland Clinic (Location, Unit / Department, Role):
Example: Hillcrest, Emergency Dept., Nurse, or Medina Hospital Trustee
I am related to a current Cleveland Clinic Caregiver, Board Member, or Trustee of Cleveland Clinic:* must provide value
Yes
No
Relative role, work/service location, name:
Example: Nurse, Hillcrest Hospital, Jane Doe
Did someone refer you to Volunteer Services?* must provide value
Yes
No
I discovered Volunteer Services in this way:
Current Volunteer
Caregiver (Employee of Cleveland Clinic)
Cleveland Clinic Website
Social Media
Special Event / Recruitment
My Cleveland Clinic Provider (Primary care, Specialist)
School (High school, College, University)
Community
Other
Current Volunteer
Caregiver (Employee of Cleveland Clinic)
Cleveland Clinic Website
Social Media
Special Event / Recruitment
My Cleveland Clinic Provider (Primary care, Specialist)
School (High school, College, University)
Community
Other
Check all that apply
Please share the name of the person(s) or event that referred you to Cleveland Clinic Volunteer Services and the circumstances:
Example: Dr. Majikas referred me during my visit with her.
Volunteer Service Interest:* must provide value
Traditional Volunteer
Concert Band Program
Healthcare Partner Volunteer (Adult)
Healthcare Partner Volunteer (Children's)
Caring Canine Volunteer Program
College Volunteer Program
Hospice Program Volunteer
Teen Volunteer Program
Spiritual Care Volunteer Program
I need more information before I choose
Other
Traditional Volunteer
Concert Band Program
Healthcare Partner Volunteer (Adult)
Healthcare Partner Volunteer (Children's)
Caring Canine Volunteer Program
College Volunteer Program
Hospice Program Volunteer
Teen Volunteer Program
Spiritual Care Volunteer Program
I need more information before I choose
Other
Check all that apply
THANK YOU for your interest in Healthcare Partner service for Children's Hospital.
This program seeks to engage the voices of those families who have been PATIENTS (or parents of patients) of Children's Hospital.
I am the parent or legal guardian of ______ ______ and I grant permission for him / her to apply to a Cleveland Clinic Volunteer Services program.
Signature is required for minors.
Please print the name of the parent or legal guardian that granted permission for this application by signing above.
Required for all minors.
We need players in ALL sections of the band. No sections are "full."
You mustBe able to play (and own or have access to) a standard band instrument (no strings, please), Be able to read music, Be an employee or Volunteer of Cleveland Clinic, or be willing to become one, Commit to attend a majority of rehearsals and performances. THAT'S ALL THERE IS TO IT! There are no formal auditions. The music is approximately at the high school band level of difficulty. It consists of marches, light concert music, show music, overtures, etc.
Describe "Other" Volunteer Opportunity of Interest:
Cleveland Clinic’s College Student Volunteer Program offers volunteer opportunities that support patients, visitors, and caregivers. Volunteers commit to a weekly set-schedule in a department/assignment during the summer. Cleveland Clinic provides complimentary parking and food credit on the volunteer day.
When considering a volunteer position with Cleveland Clinic, please review your availability with school commitments and outside obligations to meet the program requirements and attendance policy. Schedules will not be changed once a volunteer begins the program.
Volunteer shifts vary according to placement, and are subject to change based on the requesting department. Most volunteer position placement is Monday - Friday during business hours. There are limited evening and weekend volunteer positions.
College Student Volunteer Program Requirements:
Minimum 18 years of age by the information session date and enrolled in college (pre-requisite course work, undergraduate, graduate, medical school, technical school) as a full or part time student Service Hours Commitment: 75 minimum service hours for Summer; 50 minimum service hours for Fall semester; and 50 minimum service hours for Spring semester. Attend (1) mandatory in-person information session on scheduled date and time listed on the application. There are no information sessions scheduled outside the dates listed on the application. Complete all onboarding steps and meet all deadlines before start week Comply with Cleveland Clinic background check and TB test requirement Attend (1) in-person orientation on scheduled date and time as listed on the application. There are no orientations scheduled outside the dates listed. Additional training: Nursing unit and Pediatrics volunteers during business hours Respect patients and their families, and all Cleveland Clinic Caregivers Adhere to policies of the hospital, Volunteer Services and patient confidentiality Be dependable, reliable and commit to putting patients first Comply with business casual dress code and badge and uniform policy. The Caring Canine volunteer teams visit and greet on approved inpatient and/or outpatient care areas to provide uplifting moments for receptive patient and visitors, as well as Cleveland Clinic caregivers.
Volunteer Opportunities Include:
Provide pet visits for patients in approved units and areas Provide pet greeting for patients and visitors in approved units and areas Interact in a supportive, patient-focused manner with patients, family members and caregivers (special requests) Follow Infection Control guidelines including placing a covering on any surface where the canine sits or lays down. Follow Precautions guidelines as designated for each patient room/area. Maintain Patient Confidentiality Cleveland Clinic Healthcare Partners are: project, committee, and care delivery enhancement based volunteers.
Healthcare Partners are patients and family members who will provide their perspectives about the design and delivery of care at their primary care practice, hospitals, and family health centers. Clinicians, providers, caregivers and current Healthcare Partners can recommend patients, support persons and family members of patients to be a member of the Healthcare Partner program by sending nominations to volunteer@ccf.org .
Cleveland Clinic Healthcare Partners are: project, committee, and care delivery enhancement based volunteers.
Healthcare Partners are patients and family members who will provide their perspectives about the design and delivery of care at their primary care practice, hospitals, and family health centers. Clinicians, providers, caregivers and current Healthcare Partners can recommend patients, support persons and family members of patients to be a member of the Healthcare Partner program by sending nominations to volunteer@ccf.org .
Cleveland Clinic Hospice believes no one facing a life-limiting illness needs to walk alone: volunteers are needed to provide comfort and support to patients and their loved ones.Volunteer opportunities include:
Companionship and socialization for patients Vigil volunteers to provide support to loved ones as patients face the end of their journey Bereavement volunteers to provide caregivers support after the patient has passed We serve patients in their homes, skilled nursing facilities and assisted living complexes. Under the direction of Spiritual Care Department, provide patients, visitors, and caregivers in clinical and non-clinical department information about services offered through the department.
Volunteer Opportunities Include:
Distribute information on the Spiritual Care Department offerings to patients and caregivers Offer compassionate care, empathy, and nurturing care to patients and caregivers Must not evangelize and/or initiate prayer or other religious rituals or conversations, or hand out materials other than those provided by the Spiritual Care Department Share visitation requests with Spiritual Care Department Dress appropriately per Cleveland Clinic policy (dress code and PPE); volunteer must refrain from visiting patient room with precaution sign posted. Comfortable in fast paced, stressful environment Follows and adheres to all hospital and department safety requirement Receive endorsement from local faith community (For example: Pastor, Rabbi, Imam, and Priest) Eucharistic Minister Volunteers may participate in setting up for mass and mass readings
Your Dog's Name:
______ 's approximate Date of Birth:
Today D-M-Y
Canine needs to be greater than one year of age in order to volunteer at Cleveland Clinic. How long have you had ______ :
Please enter number of years
What breed of dog is ______ :
Any Additional Information about ______ that may be important:
The Healthcare Partner program is interested in your input and input from other patients, families or support persons, how would you like to provide input? For example: (read list below):
Joining a group that meets regularly (once per month or once per quarter)
Working on a special project with defined goals
Offering input on construction and space planning such as exam rooms and waiting areas
Joining a committee focused on patient safety or quality standards
Joining a committee focused on ethics
Speaking publicly about your experience (Caregiver meetings, Town halls)
Participating on research projects (to improve patient experience, not medical / clinical)
Responding to surveys or electronic feedback
Videoconferencing in to meetings
Peer to Peer Networking & Support
Joining a committee focusing on Healthcare Partner program growth / strategy
Volunteering in the Our Voice: Healthcare Partner program office
Joining a group that meets regularly (once per month or once per quarter)
Working on a special project with defined goals
Offering input on construction and space planning such as exam rooms and waiting areas
Joining a committee focused on patient safety or quality standards
Joining a committee focused on ethics
Speaking publicly about your experience (Caregiver meetings, Town halls)
Participating on research projects (to improve patient experience, not medical / clinical)
Responding to surveys or electronic feedback
Videoconferencing in to meetings
Peer to Peer Networking & Support
Joining a committee focusing on Healthcare Partner program growth / strategy
Volunteering in the Our Voice: Healthcare Partner program office
Please check all that apply
If sharing your point of view is part of your role, the focus will be on:
A patient (yourself)
A patient for whom you are/were a primary, designated support person
A patient for whom you provide support as family member or loved one
A patient (yourself)
A patient for whom you are/were a primary, designated support person
A patient for whom you provide support as family member or loved one
Please check all that apply
What excites you about being a Cleveland Clinic Volunteer?* must provide value
What is one thing you would like to see Cleveland Clinic do differently?
Commitment Overview and Confidentiality AgreementCleveland Clinic Volunteers are patients, family members and/or support persons who work together with Cleveland Clinic Caregivers to transform healthcare and support our vision of Patients First and providing relationship-centered care. Patients, support persons and caregivers as partners for better health Improving Healthcare through collaboration Volunteers serve in many different ways to improve healthcare through collaborative efforts with leadership, caregivers, healthcare partners and the community. The Cleveland Clinic appreciates the critical role you will play in transforming healthcare. Volunteers will be invited to participate in a variety of ways including: • Traditional scheduled volunteerism: Gift Shop, Way-finding, activities, clerical, and administrative assignments, internships, patient visitation, spiritual care services, and special group meetings • Caring Canine Greetings and Visitations • Improving the inpatient, outpatient and surgical experiences • Construction and Space planning (e.g. exam rooms, waiting areas) • Participating on committees focused on improving quality, patient safety, population health and ethics • Speaking about your experience to staff members at the Cleveland Clinic • Participating in research projects • Responding to surveys or electronic feedback Participation may occur throughout the Cleveland Clinic including main campus, regional hospitals, outpatient family health centers and primary care practices. As a Volunteer, you will be invited to share your perspective on the Cleveland Clinic, its culture, approaches to and delivery of care and the patient experience. Often this will occur in a group setting with other participants present; and therefore, some confidentiality may be lost by revealing information in a group setting. We ask that you respect one another's' confidentiality and not discuss names or other identifying information of patients, families, and support persons connected with the program or the Cleveland Clinic. Similarly, the Cleveland Clinic will not share any individually identifiable information obtained as a result of participating in the Our Voice: Healthcare Partner program. More specifically: • Confidential information may be discussed between Volunteers and Cleveland Clinic Caregivers. Such confidential communications must be kept confidential and within participants of this program. • You may not communicate confidential information outside of the Volunteer scope of service or direct others to undertake aspects of the work. • You must respect the private and sensitive nature of this program. • All information shared during or related to this program shall be used only within the context of this program. Participants selected to be Cleveland Clinic Volunteers are asked to commit to one year of service. An option to rejoin for one additional year may be discussed at the conclusion of the first year of service. Cleveland Clinic may remove a participant from the program at its discretion. There will be no compensation for participation. Participants selected will complete an on-line on boarding process, attend an orientation session and receive information regarding the specific schedule required for their assignment prior to their start. By signing below and participating in the Cleveland Clinic Volunteer Program, you understand that you are choosing to abide by the guidelines described above. While the Cleveland Clinic respects and abides by its regulatory obligations regarding privacy and ensures all reasonable measures are taken to protect information, it may not be able to completely safeguard the privacy and confidentiality of what you choose to discuss or responses offered. Therefore, you agree that the Cleveland Clinic shall not be liable for any financial or other damages resulting from the shared nature of this program and/or other participants in the program. In accordance to the Cleveland Clinic's commitment to maintaining the privacy of its patients, you also agree to protect the privacy of other CC Volunteers by not identifying other participants or discussing their personal information and/or medical condition outside of the Volunteer Program. By signing below, I acknowledge that I have read and agree to abide by the requirements stated above. (Click Add Signature and use your mouse to sign your name in the box below)
* must provide value
I would consider attending meetings virtually (from a distance by computer) using the following ways to connect:* must provide value
Zoom Meeting
Microsoft Teams
Google Hang Out
Skype
GoToMeeting
Cisco WebEx Meeting Center
FaceTime
I would not attend a meeting virtually.
Zoom Meeting
Microsoft Teams
Google Hang Out
Skype
GoToMeeting
Cisco WebEx Meeting Center
FaceTime
I would not attend a meeting virtually.
Training and connection information would be provided to you. There would be no cost for computer / mobile device download.
I am most interested in volunteering at:* must provide value
Hospital
Family Health Center / Medical Office Building / Outpatient
Hospice (Mobile)
Other
Hospital
Family Health Center / Medical Office Building / Outpatient
Hospice (Mobile)
Other
Describe "Other" area of volunteering:
I am most interested in volunteering at this hospital:
Akron General Medical Center Ashtabula County Medical Center Avita Health System Bucyrus Hospital Avita Health System Galion Hospital Avon Hospital Cleveland Clinic Abu Dhabi Cleveland Clinic Children's Cleveland Clinic Children's Hospital for Rehabilitation Cleveland Clinic London Cleveland Clinic Main Campus Cleveland Clinic Weston Florida Euclid Hospital Fairview Hospital Hillcrest Hospital Indian River Justin T Rogers Care Center / Hospice Care Lodi Hospital Lutheran Hospital Cleveland Clinic Martin North Hospital Cleveland Clinic Martin South Hospital Cleveland Clinic Martin Tradition Hospital Marymount Hospital Medina Hospital South Pointe Hospital Union Hospital Weston Hospital Other
I am most interested in volunteering at this Family Health Center / Medical Office / Outpatient Setting:
Akron General Center for Family Medicine Akron General Primary Care Stow Akron General Suburban South Family Physicians Al Ain (Abu Dhabi) Ambulatory Services Center Vero Beach, Florida Amherst Family Health Center Avon Family Health Center (Richard E. Jacobs) Avon Pointe FHC Avon Town Center Bainbridge Urgent Care Bath Medical Group Beachwood Family Health Center Behavioral Health Center Vero Beach, Florida Belden Center, Medical Outpatient Center Broadview Heights Family Health Center Brunswick Family Health Center CC Building 509 (Martin Health, Florida) Canal Physician Group Cancer Center Mansfield, OH Cancer Center Sandusky CC Beachcliff Rocky River CC Canada Downtown CC Canada Midtown CC Center for Autism CC Children's Rehabilitation Therapy Services- BEACHWOOD CC Children's Rehabilitation Therapy Services- MEDINA CC Children's Rehabilitation Therapy Services- MIDDLEBURG HTS. CC Children's Rehabilitation Therapy Services- STOW / FALLS CC Children's Rehabilitation Therapy Services- WESTLAKE CC Family Health Center Stuart, Florida CC Florida Wellington CC Internal Medicine - Ohio City CC Internal Medicine - Severance CC Main Campus Internal Medicine CC Rehabilitation Hospital Avon CC Rehabilitation Hospital Beachwood CC Rehabilitation Hospital Edwin Shaw Chagrin Falls Family Health Center Charleston Medical Center Charleston, Virginia Chesterland CPCP Concord Medical Center Egil and Pauline Braathen Medical Center Weston, Florida Elyria Family Health Center Euclid Medical Office Building Fairview Medical Office Building Family Medicine - Rockport Family Medicine - Rockside Road, Independence Family Medicine - Valley City Green Primary Care Health and Wellness Center Vero Beach, Florida Hillcrest Medical Office Building Independence Family Health Center Indian River Internal Medicine Center of Akron Justin T Rogers Care Center / Hospice Care Krupa Center Weston, Florida Lakewood Family Health Center Langston Hughes Center Cleveland Clinic Community Health and Education Center Lodi Community Care Center Lorain Family Health Center Lou Ruvo Center for Brain Health - Las Vegas, Nevada Madison Medical Office Building Martin Health at Hobe Sound Martin Health at Jensen Beach Martin Health at Palm City Martin Health at Smithfield Plaza Martin Health at St. Lucie West Martin Health at Tiffany Martin Health at Tradition Park One Martin Health at Tradition Park Two Martin Health, Patricia Lichtenberger Medical Plaza Martin Health, Robert and Carol Weissman Cancer Center Martin Medical Office Building and Surgery Center Martin Rehabilitation and Fitness Center Marymount Medical Office Building Medina Medical Office Building Mentor Medical Office Building Moll Cancer Center at Fairview Hospital Montrose Primary Care North Olmsted Medical Office Building Palm Beach Gardens Parkland: Parkland, Florida Partners in Women's Health Vero Beach, Florida Pointe West Primary Care and Walk In Care Vero Beach, Florida Scully-Welsh Cancer Center Vero Beach, Florida Sheffield Family Health Center Solon Family Health Center South Pointe Medical Office Building South Russell CPCP Stephanie Tubbs Jones Health Center Strongsville Family Health Center Summit Adult Medicine Center Tomsich Health and Medical Center of Palm Beach County West Palm Beach, Florida Twinsburg Family Health Center Union - New Philadelphia Union- Alpine Family Medicine Union- Newcomerstown UPS Union Physician Services Union- UPS Family Health Center North Wadsworth Primary Care/Express Care Walker Center Weston Family Health Center Willoughby Hills Family Health Center Wooster Family Health Center Wooster Milltown Specialty and Surgery Center None Other
I am most interested in volunteering & interacting with:* must provide value
Adults
Infants (Less than 2 years old)
Children (ages 2 - 12)
Teens (13-18)
Patients and Families at End of Life Care
Roles that do not interact with current patients
Cleveland Clinic Caregivers (Caregivers refers to those who are employed to work at Cleveland Clinic)
Adults
Infants (Less than 2 years old)
Children (ages 2 - 12)
Teens (13-18)
Patients and Families at End of Life Care
Roles that do not interact with current patients
Cleveland Clinic Caregivers (Caregivers refers to those who are employed to work at Cleveland Clinic)
Check all that apply
Opportunities to volunteer with Infants and Children patients are not available at the following locations at this time: Cleveland Clinic Family Health Centers & Medical Office Buildings Hospice Ashtabula County Medical Center Avita Health System Bucyrus Hospital Avita Health System Galion Hospital Avon Hospital Cleveland Clinic Abu Dhabi Cleveland Clinic London Cleveland Clinic Weston Florida Euclid Hospital Hospice Care Indian River Justin T Rogers Care Center / Hospice Care Lodi Hospital Lutheran Hospital Lou Ruvo Center for Brain Health Martin North Hospital Martin South Hospital Martin Tradition Hospital Marymount Hospital Medina Hospital South Pointe Hospital Union Hospital Weston Hospital
I have previous and / or current volunteer experience.* must provide value
Yes
No
I have had previous Hospice experience.
Yes
No
Please share more about your Hospice experience:
Dates of Service with Hospice
Role with Hospice
Relationship with Hospice
Location(s) Served
Any Additional Information
Share as applicable
Please share your previous volunteer experience information:Location of Service
Dates Served
Approximate Hours contributed
Reason for discontinuing service (if applicable )
I acknowledge the following: I must renew my Cleveland Clinic badge annually, with my Cleveland Clinic Volunteer Coordinator. I must receive an initial and annual TB test, required for participation in the Cleveland Clinic Volunteer program. TB testing is available to me at Cleveland Clinic Occupational Health at no cost to me. As part of the onboarding and badge renewal, designated Cleveland Clinic Non-Employee onboarding software, will be utilized. Within the designated Cleveland Clinic Non-Employee onboarding software, I will be asked to sign: policy agreements; media release form; consent to participate form and background check permissions, which require me to provide my social security number in a fire wall protected database. Fingerprinting is required for volunteers who will be near / with children and vulnerable populations.
Please click the link below "ADD SIGNATURE", to add your signature using your mouse.
* must provide value
I am a United States citizen:* must provide value
Yes
No
Please share your VISA type, for further consideration.
Individuals who are not U.S. citizens, but who reside in the U.S., may volunteer
(1) if they are a lawful permanent residents; or
2) if they are non-immigrant aliens with F-1 or J-1 visa status, who are bona fide students residing in the U.S. solely to pursue a course of study at a recognized, approved institution of education.
Foreign students may volunteer with a Federal natural resource agency if they have successully received permission to engage in Optional Practical Training (OPT), Curricular Practical Training (CPT) or Academic Training (AT).
For more information and instructions, students should consult the international student advisor at their university. An offer of employement or verification of a volunteer placement must be submitted with the student's application for OPT, CPT or AT. F-1 student visa holders may be required to submit applications for off-campus training and work to the international student advisor and United States Citizen and Immigration Services (USCIS) several months in advance of the proposed start date of the program. J-1 student visa holders may participate in academic training with the approval of their academic advisor and the J-1 responsible officer at their sponsor organization or institution.
Source :https://www.volunteer.gov/faq.cfm
Enter Visa Type Here
Thank you for your interest in Cleveland Clinic Volunteer Program. Please share anything more that you would like us to know, below:
NOTES:
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