College Student Volunteer Program
Volunteer Services
Main Hospital, 1st Floor
804-828-0922
Fax 804-828-4752
1250 E. Marshall St.
PO BOX 980256
Richmond, VA 23298
Summer 2016
Volunteer Application Process
The Application is for undergraduate and graduate students who wish to become volunteers.
Previous or current volunteers, check with Volunteer Services for any required updates.
We are excited that you are interested in volunteering at VCU Health! If you would like
to become a volunteer, you must complete the following steps:
1. Make sure you are available to volunteer for at least eight (8) weeks from June-August.
Shifts are weekly (the same day, the same time each week) and are scheduled for a minimum
of two hours. Any questions about this requirement should be directed to Volunteer Services
before completing the full Volunteer Application Process.
2. Complete the attached application (both pages) and return it to Volunteer Services no later
than 4:00pm on May 13, 2016. Our address and fax number are listed on the top of this page.
You must have and provide a Social Security Number to volunteer at VCU Health, as it is
necessary to perform our required criminal background checks.
3. Complete the health screening requirements listed on the attached Health Screening Form
and return it to Volunteer Services with accompanying documentation no later than 4:00pm on
May 25, 2016 (see the form or the next page for details). Our address and fax number are
listed at the top of this page, and the fax number is also on the Health Screening Form.
4. You must come IN PERSON to the Volunteer Services Office between the hours of 9:00am
and 4:00pm on a regular business day (Mon-Fri, except major holidays), between May 16 and
May 25, 2016, to discuss the available opportunities and choose a placement. Opportunities
are filled on a first-come, first-served basis. Your application and health documents must
be completed and received by us in order for you to choose a placement.
5. Attend Orientation. On your application you will indicate which session(s) you are able to
attend. Space is limited in each session; we will confirm which session you are expected to
attend when you come to Volunteer Services to choose a placement. On the day of Orientation
you must arrive on time and plan to stay for the entire session. Bring a pen and a
government-issued photo ID (Driver’s License or passport) with you.
PLEASE SEE NEXT PAGE 
IMPORTANT HEALTH SCREENING INFORMATION
You must submit your health documentation NO LATER THAN 4:00pm on May 25, 2016. We must see
documentation of ALL of the following (please contact Volunteer Services if you need to clarify):
o Chicken pox


o
MMR (Measles, Mumps, Rubella)


o
If you have had chicken pox: date you had disease or date and results of titer (must be positive)
If you have not had chicken pox: dates of 2 doses of live Varicella vaccine
Dates of 2 vaccines (both must be AFTER your first birthday) OR
Dates and results of titers (must be positive)
TB (Tuberculosis) test results (all testing must be performed in the United States)



If you have had a skin test after May 1, 2015: documentation of that test and one more skin test placed
AND read between March 28, 2016 and May 25, 2016
If you do not have documentation of any TB skin tests after May 1, 2015: a Two-Step TB skin test: the
two tests must be placed 7-21 days apart; completed between March 28 and May 25 OR
IGRA Quantiferon Gold or T-Spot blood test for TB, done on or after March 28, 2016
If you have a history of a positive skin test: Documentation of the positive skin test AND
Results of chest x-ray (performed in the United States) within the last six months
FREQUENTLY ASKED QUESTIONS
Do I have to have another TB test if I had one recently?
New volunteers must provide documentation of TWO TB tests as explained above. Please call us if you need to clarify.
Where can I get my TB test(s)?
At your primary care physician, your school’s student health office (contact your student health office to verify hours and
any applicable fees), or a walk-in clinic in the community. Students will not receive TB tests here at the hospital.
What if I always have positive TB skin tests? Do I need a chest x-ray?
Employee Health will need to see a record of a previous positive skin test and a copy of a chest x-ray report within the last
6 months (for new volunteers). If you are not sure if you need one, please call us or turn in a copy of your last x-ray report
and your immunization records to us as soon as possible so that we can check with Employee Health.
Can I park at the hospital when coming to Volunteer Services or while volunteering?
VCU students can use the Campus Connector from the Monroe Park campus; students are not allowed to park in the
Patient & Visitor deck or use valet services. For information about the Campus Connector, check the VCU Parking &
Transportation website. If you are not a VCU student or have special circumstances, check with us in advance.
How do I get to Volunteer Services?
Printable directions can be found under the “Contact Volunteer Services” link at www.vcuhealth.org/volunteers.
Why do I have to have a Social Security Number in order to volunteer?
Background checks are required for all new volunteers and employees, in order to protect our patients, visitors, and team
members. SSN is required to perform those background checks.
When can I sign up for a volunteer shift?
Sign-ups will be done on a first-come, first-served basis in person in the Volunteer Services office from May 16-May 25.
We must have received your completed application and health documents (by May 25) in order for you to sign up.
COLLEGE/GRADUATE STUDENT
VOLUNTEER APPLICATION
Summer 2016
Please Print Neatly
Name _______________________________________________________________
(Last)
(First)
Nickname __________
(Middle)
M __ F __ Date of Birth _________
(if applicable)
SS# (required)_______________
(you must have and provide a Social Security Number to volunteer)
Program or
School you attend _________________________
Graduation
Major _______________ Year ____________
VCU Students: Your VCUCard # _____________________________ Prox # _________________
(16 digit number on front of ID card)
(5-6 digit # on back of ID card)
Local Address ____________________________________________________________________
(Street)
(Apt/Dorm #)
(City, State, Zip)
Phone # ____________________ Email Address _______________________________________
Have you volunteered with us before? _____If yes, when and where______________________
Why are you interested in volunteering at this medical center?
________________________________________________________________________________
________________________________________________________________________________
What do you expect to gain from your volunteer experience?
________________________________________________________________________________
________________________________________________________________________________
Have you ever been convicted of a misdemeanor or a felony?* Yes ________ No _________
If yes, please explain: _____________________________________________________________
________________________________________________________________________________
(*background checks will be performed on all volunteers at orientation, prior to beginning to volunteer)
In case of emergency, we should contact:
Name __________________________________ Relationship to you ______________________
Phone Number(s) __________________________________________________________________
BE SURE TO COMPLETE PAGE 2 
ORIENTATION
Please circle ALL of the session(s) that you are able to attend:
(we will confirm your session when you sign up for a placement; space is limited in each session)
Tuesday
Tuesday
Tuesday
May 31
May 31
May 31
11:00am-12:00pm
3:30-4:30pm
5:30-6:30pm
APPLICATION AND AGREEMENT
I hereby apply for a volunteer position at VCU Health. I agree that if I become a volunteer, I
will comply with the requirements and regulations that apply to volunteers. In exchange for
the valuable experience provided to me by VCU Health, I will fulfill my commitment of a
minimum of 2 hours per week for at least eight (8) weeks from June-August (exceptions to this
requirement will be handled on an individual basis). I further understand that my chosen
department(s) will rely on me and if I fail to keep this commitment, I may not be eligible to
receive a reference letter from Volunteer Services or to volunteer in the future.
_______________________________________
Applicant Signature
_____________________
Date
FOR OFFICE USE ONLY
Date Received/ Completed
Application
Date Sent for
Review/Approval
N/A
EGI
Health Record
Notes:
Date Entered________________
Coordinator Initials____________
Page 2
Health Screening Form for Volunteer Applicants (College)
Summer 2016
APPLICANT: Return this form with the documentation outlined below to Volunteer
Services (in person or fax to 804-828-4752) no later than 4:00pm on May 25, 2016
Name ____________________________ Date of birth _________ Phone number _________________
Address ___________________________________ City _______________ State ____ Zip _________
I understand that providing documentation of the information below is a condition of being permitted to volunteer
at VCU Health. I authorize my physician or Student Health office to provide such documentation and to provide
any vaccines or TB skin tests necessary to complete the requirements.
Applicant Signature ____________________________________ _
Date _______________
If applicant is under 18, a parent or guardian signature is required:
Parent/Guardian _________________________ Print Name ______________________________
DOCUMENTATION REQUIRED FROM PHYSICIAN / HEALTH OFFICE:

Chicken Pox: Must show one of the following:
o Date of disease (provide physician’s record) OR
o Date and results of positive titer (attach lab report) OR
o Dates of vaccinations (physician’s record of 2 doses of Varicella)

MMR (Measles, Mumps and Rubella): Must show one of the following:
o Dates and results of positive titers (attach lab reports) OR
o Dates of vaccinations (physician’s record of 2 doses of MMR vaccine; both must be AFTER
first birthday)

TB (Tuberculosis) test results (Tests must be completed in the United States):
If the applicant has had a skin test since May 1, 2015:
o documentation of that test AND
o one more skin test placed AND read between March 28, 2016 and May 25, 2016
If the applicant does not have documentation of any TB skin tests since May 1, 2015:
o a Two-Step TB skin test: the two tests must be placed 7-21 days apart; completed
(placed AND read) between March 28, 2016 and May 25, 2016 OR
o IGRA Quantiferon Gold or T-Spot blood test for TB, done on or after March 28, 2016
If the applicant has a history of a positive skin test:
o Documentation of the positive skin test AND
o Results of chest x-ray (performed in the United States) within the last six months
TO BE COMPLETED BY VCU HEALTH
Program _COLLEGE VOL_
Contact ___________________________
Phone _8-0922_
Date ____________
Vol Svcs 11/14, 3/15. 3/16