PRE-ASSIGNED VOLUNTEER APPLICATION
If you will be working with patients or in a patient care setting, you must be available for an in-person health screening in Ann Arbor on the date of your choice during the next six weeks. If you are not able to do so, please stop now. Your application will not be accepted. Please apply later when you are able to attend an in-person health screening.
Required Fields are marked with an asterisk
(*)
Citizenship and Visa Information
NOTE: Please upload a copy of your visa with at least one form of supporting documentation.
Emergency Contact Information
Criminal Records Check Information
If you are not available for a health screening, please stop now. Your application will not be accepted. Please apply later when you are able to attend an in-person health screening.
Note: Minimum 40 hrs or 90 days, whichever comes first
Please give three character references (they could be work, academic, or personal) who can respond to our inquiry about you.
Please note that answering the following questions about ethnicity, gender identity, personal pronoun, and sexual orientation
is optional. Our goal is to serve every patient and family who receives care at Michigan Medicine, and these
details help us ensure that our volunteer corps reflect the diversity of our patient population.
PFE Advisor and Mentor Volunteer Placement Information
The following questions assist us with your volunteer placement. Most of our placements are for a specific
diagnosis or patient experience. Answers to these questions are kept in a password protected database.
Your Volunteer Perspective
Your Health Details (If a Michigan Medicine Patient)
Family Member Health Details (If Relevant)
Bereaved Family Member Details:
Current Family Member Details:
Patient Experience Biography
I certify that my answers are true and complete to the best of my knowledge. I agree that this information has been verified and references may be contacted by Michigan Medicine Volunteer Services.
I, the undersigned, authorize the University of Michigan, on behalf of Michigan Medicine, to conduct a criminal history check and review of the Federal Exclusion Lists. These checks will be performed to evaluate whether I am qualified to volunteer at the University of Michigan.
I understand that Michigan Medicine will contract with an outside vendor to conduct these investigations utilizing names and identifiers to determine the existence of any arrest resulting in conviction and furnish a response to Michigan Medicine.
I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for volunteering will not be processed further. Misrepresentation of facts constitutes cause for separation from Volunteer Services.
NOTE: This application expires in 30 days. If the volunteer applicant does not respond to required onboarding actions, the application must be resubmitted to Volunteer Services.