VS Project Outreach Application

Welcome!

Thank you for your interest in volunteering at U-M Health. Please complete an application form to be considered for volunteer placement.

Minimum Volunteer Requirements

Only complete an application form if you meet all requirements.

18 years of age or older
Willing to commit to at least one 3-4 hour volunteer shift per week for at least six months or two complete terms for students
Volunteers do not receive monetary compensation
First-year college students please wait until at least your second semester before volunteering

Are you available to attend an in-person health screening in Ann Arbor on a date of your choice during the next six weeks?

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.

PROJECT OUTREACH VOLUNTEER APPLICATION

Required fields are marked with an asterisk (*)

When are you available to volunteer? Check all that apply.

Fall Semester 2025 September - December

Winter Semester 2026 January - April

If accepted to volunteer, will you enroll in Project Outreach (Psych 211)?

Volunteer Information

* First Name (Legal)

M.I.

* Last Name (Legal)

First name (preferred)

* UMID Number (If known, this could expedite your application.)

* Local Address

Apt #

* City

State

* Zip Code/Postal

* Permanent Address

Apt #

* City

State

Zip Code/Postal

Country

* Phone (Cell)

Alternate Phone if no cell

Sex

* Date of Birth (MM/DD/YYYY)

Is Applicant a Minor? If yes, stop here. You must be at least 18 years of age to apply.

Which of these best describes your connection to the University of Michigan? If two or more apply, choose the one you feel defines your role at U of M best.

If you are an employee or learner of Michigan Medicine (not University of Michigan campus), please upload a photo of your employee ID badge.

Citizenship and Visa Information

Citizenship

Visa/Status Type (Please select)

Visa - other

Status Exp. Date

NOTE: Please upload proof of status and at least one form of supporting documentation.

Visa (Upload image)

Visa Supporting Documentation such as I 20, EAD Card, DS 2019 forms, and/or I-94

Emergency Contact Information

(copy)

* Emergency Contact Name First/Last (Local)

* Relationship

* Primary Phone Number

* Emergency Contact Name First/Last(Family)

* Relationship

* Primary Phone Number

Criminal Records Check Information

Have you ever been convicted of a misdemeanor or a felony?

Are there any felony charges pending against you?

Is there anything in your history you want to tell us before we run your criminal background check? If yes, please describe below.

Current School Information

School

Year in School

Graduation Month

Graduation Year

Major

Relevant Professional or Volunteer Experience

Organization

Dates From/To

Responsibilities

Organization

Dates From/To

Responsibilities

Organization

Dates From/To

Responsibilities

References

Please give three character references (they could be work, academic, or personal) who can respond quickly to our inquiry about you. References should have known you for at least six months.

Reference #1

* Reference Full Name

* Reference Email

* Reference Phone

Reference #2

* Reference Full Name

* Reference Email

* Reference Phone

Reference #3

Reference Full Name

Reference Email

Reference Phone

Interview Questions

* What interests you about volunteering with Michigan Medicine?

Volunteer Placement Choices

In preparation for your interview, please checkmark the placements that interest you. NOTE: Volunteer Services is not guaranteeing that there will be volunteer placement offered to you, or that one of your top choices will be available at the time of your interview.

Job preferences (as checklist)

Ann Arbor Meals on Wheels

Brighton Health Center (8001 Challis Rd., Brighton)

Clerical (Main hospital campus)

East Ann Arbor Healthcare Center (4260 Plymouth Rd., Ann Arbor)

Gift Shop (Main hospital campus)

Kellogg Eye Center (accessible by UM Blue Bus)

Main Hospital Campus (University, Mott, & Von Voigtlander Hospitals; Rogel Cancer, Frankel Cardiovascular)

Michigan Medicine Domino's Farms (24 Frank Lloyd Wright, Ann Arbor)

Northville Health Center (30001 Traditions Dr., Northville)

Performance: Musicians, Magicians etc. (auditions required)

Turner Senior Resource Center (Accessible by UM Blue Bus)

Your special interests or other

If 'Your special interests or other' is checked, please describe.

Placement is contingent upon volunteer availability and shift schedule, as well as successful completion of orientation, training, and health screening.

Please check mark each location where you can serve reliably.

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.

* (check box for agreement)

* Type your full name.

* Date