Volunteer Handbook - Roper St. Francis Healthcare

Students applying for Shadowing or Mentoring Programs fill in this section: SCRUBS Mentoring PT/OT Shadowing Coding Externship MHAHow did you hear about the Mentoring Program? _________________________________________All students fill in this section:What school do you attend?: _______________________ Educational level: __________________What is your career interest at this time: ________________________________________________Where do you hope to continue your chosen career? (Schools, university): _________________What year do you anticipate starting? ______________________ Graduating? _____________Comments: _______________________________________________________________________How many hours do you anticipate observing/serving? ____________Minors: Students 15 – 18 should fill in this section:Why would you like to volunteer? (Mention hours needed for community service, required observationhours, etc.): _____________________________________________________________________Parent’s Consent: My daughter/son has my permission to work as a student volunteer at Roper St. Francis Healthcare.I believe that he/she is physically able and mature enough to fulfill the duties to which he/she has been assigned andabide by the schedule, safety, infection control policies and privacy standards as outlined in the Orientation Handbook.Documentation of service hours and transportation is the student’s responsibility. I understand that my signature isrequired for the necessary TB health screening and will provide documentation of childhood immunizations.Parent or Guardian Signature: _________________________________ Date: _________________________________________________________________________________I understand that Roper St. Francis Healthcare reserves the rights to accept or reject my application in its sole discretionand that the above statements made in this application are true. I understand that my service will be in accordance withthe general personnel policies and guidelines of Roper St. Francis Healthcare, Inc. I understand that I may quit at anytime with or without cause and should the Coordinator of Volunteers feel that the interests of the hospital are best servedby relieving me of my assignment or transferring me to another service, I agree to accept her decision as final.Believing that the hospital has a real need of my services as a volunteer worker who serves without pay, I will uphold theStandards of Behavior and Mission of Roper St. Francis Healthcare.Signature: _________________________________________________ Date: ______________Return application to the facility you are interested in:Roper Hospital 724-2828Volunteer Office, 316 Calhoun St., Charleston, SC 29401Bon Secours St. Francis Hospital 402-1156Volunteer Office, 2095 Henry Tecklenburg Dr., Charleston, SC 29414Mount Pleasant Hospital (send to St. Francis Hospital address above) 606-7000Revised 2/2009