Thank you for your interest in the Junior Volunteer Program at Saint Agnes Medical
Center. Our program is designed to give students between the ages of 14 to 18 (attending
high school) an opportunity to gain exposure to a medical environment.
During the year we have approximately 200 Junior Volunteers in our program, assisting
staff in various departments throughout the Medical Center. The program requires a
commitment of 60 hours per year, which works out to approximately one 3-hour shift
every other week. Junior Volunteer hours are scheduled after school and on weekends.
Additional hours are also credited for activities such as serving as a board officer or
service chairperson, attending general meetings and community service projects. Juniors
are recognized annually for their hours of service at an Appreciation Banquet held in the
spring.
A student interested in becoming involved with this program must be prepared to make
a commitment to volunteer on the day & hours assigned, maintain a 3.0 GPA,
complete an application, and attend orientation.
Our Junior Volunteer Orientation is held once a year after the school year ends. Students
are expected to purchase the required uniform after orientation.
Please return the application with a copy of your last report card (does not need to be an
official transcript), to the volunteer office:
Saint Agnes Medical Center, Volunteer Services
1303 E Herndon Ave Mail Stop 700
Fresno, CA 93720
If you meet all the qualifications you will be notified of the date & time of the next
orientation approximately a month before.
Thank you again for considering donating your time at Saint Agnes Medical Center as a
member of our Junior Volunteer Program.
Questions? Call the volunteer office at 559.450.3521, Monday through Friday 8:30am4:30pm.
SAINT AGNES MEDICAL CENTER
APPLICATION FOR JUNIOR VOLUNTEER PROGRAM
Departmental Use Only
Jr. Vol. #
Jr. Badge #
TB Test
Assignment ________________________
Consent:
Competency ________________________
Ref. Ltr:
Orientation _________________________
PLEASE BE SURE TO COMPLETE IN FULL
DATE: ___________________
(APPLICANTS MUST SECURE ALL NECESSARY SIGNATURES BEFORE SENDING IN THIS
APPLICATION).
NAME
PHONE: HOME/CELL
ADDRESS
CITY _
EMAIL
AGE
HIGH SCHOOL_____________
ZIP
DATE OF BIRTH
.YR OF GRADUATION
GRADE POINT AVERAGE
SPECIAL INTERESTS OR HOBBIES:
IN CASE OF EMERGENCY NOTIFY
PHONE
PHONE
ARE THERE ANY REASONABLE ACCOMMODATIONS THAT WE NEED TO BE AWARE OF IN
ORDER FOR YOU TO VOLUNTEER?
IF YES, PLEASE EXPLAIN:
REFERENCES- TWO SOCIAL, BUSINESS OR RELIGIOUS (PLEASE OBTAIN SIGNATURE OF
THE INDIVIDUALS WHOM YOU ARE USING AS REFERENCES).
NAME ___________________________________ SIGNATURE ________________________________
ADDRESS ______________________________________________________ PHONE ______________
NAME ___________________________________ SIGNATURE ________________________________
ADDRESS ______________________________________________________ PHONE ______________
JUNIOR VOLUNTEER CONTRACT
I am interested in becoming a member of the Saint Agnes Medical Center Junior Volunteer Program and
will assume full responsibility for completing the hours that I am scheduled and for performing my assigned
duties.
I promise to abide by the ethics and regulations pertaining to my specific service.
I will wear my uniform with dignity and conduct myself at all times in a manner of credit to the junior
volunteer program and Saint Agnes Medical Center.
SIGNATURE OF JUNIOR VOLUNTEER APPLICANT
PARENTAL CONSENT FORM
My child,
, has my permission to be
a Junior Volunteer at Saint Agnes Medical Center.
I understand that junior volunteers are expected to serve during their
scheduled time- generally 2-3 hours every other week. If not able to work,
the junior volunteer is responsible for obtaining a substitute within the
junior volunteer program or contacting the volunteer office to excuse their
absence prior to their scheduled shift.
I will help impress upon my child the responsibility of being a volunteer and
help him/her decide if he/she can accept the additional responsibility.
I realize that uniforms are required and must be purchased at our own
expense and that a TB skin test is required before a volunteer assignment,
and each year thereafter. Annual seasonal flu shot is also required, and will
be provided to the student at no expense. I also recognize that it is my
responsibility to provide safe transportation to and from Saint Agnes
Medical Center.
Signature of parent or guardian: ___________________________________
Date: _____________________________
To The Counselor/Dean/Teacher of, _____________________________:
_______________________________________ has indicated an interest in
becoming a volunteer at Saint Agnes Medical Center. Hospital volunteering
is one of the most demanding kinds of volunteer work. It offers many
learning experiences and exposure to many health-related careers.
However, it does require people who are relatively self-directed. For this
reason, we feel we must restrict the program to those persons who are
mature enough to work well in an acute care hospital setting.
Although school performance as measured in grades or citizenship does not
always accurately reflect a young person’s abilities, it is often an indicator
of how well a student performs in a setting with specific expectations and
limitations.
In view of your past knowledge of and experience with this young person,
do you feel he/she is ready to act responsibly in a hospital situation? We
would appreciate your comments below.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Counselor/Dean/Teacher
Signature:____________________________
Date: ____________________________
Please Return Completed Application To:
Saint Agnes Medical Center, Volunteer Services
1303 E Herndon Ave Mail Stop 700
Fresno, Ca 93720