Required Fields are marked with an asterisk (*)

Volunteer Information

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

Placement Information

NOTE:  Work with Patient/Client means "in the room" with Patients/Families/Study Participants/Clients/Members.

Proposed Schedule

Note: Maximum 1 year (Annual Update required if extending past 1 year)
Note: Minimum 40 hrs or 90 days, whichever comes first
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 authorize the University of Michigan Health System, through the Department of State Police Central Records Division, the University of Michigan Department of Public Safety and Security or any agency to conduct criminal history check or investigation by name and identifiers to determine the existence of any arrest resulting in conviction and furnish a response to Michigan Medicine. 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.