Teen Volunteer application questionnaire (Summer 2019)

Question Title

* 1. Last Name and email (as provided on volunteer application)

Name

Email Address

Question Title

* 2. School you currently attend

Question Title

* 3. What grade will you be in 2019-20 school year?

12th Grade

11th Grade

10th Grade

9th Grade

Graduated

Question Title

* 4. Why do you want to be a teen volunteer at UPMC Children's Hospital of Pittsburgh? What are you interested in learning from this experience?

Question Title

* 5. Do you have any previous experience working and/or interacting with younger Children? If so, please tell us more about your experience(s).

Yes

No

If you've answered yes, please specify:

Question Title

* 6. If you've had regular interactions with young children in work/volunteer roles, what was the most rewarding takeaway from your experiences?

Question Title

* 7. On the contrary, what was the most challenging thing you've experienced when interacting/working with children?

Question Title

* 8. What other volunteer and/or work experience do you have? Have you worked with young kids and/or have you been in hospital environment?

Question Title

* 9. Can you make a commitment to volunteer at least six hours per week (either two shifts on same day or two separate three hour shifts) through minimum of eight weeks during the Summer months?

Yes

No

Question Title

* 10. This program requires teen volunteers to display a variety of traits: responsibility, working independently to complete projects, good listening skills, patience, attention to detail, and a willingness to learn. Choose two traits from this list and describe ways you display them in your current life experiences in school, work, volunteer, activities, etc.

Question Title

* 11. I am only interested in taking part in this program to complete the minimum community service requirement for school or a related educational program.

True

False

Question Title

* 12. I am only seeking clinical experience, either by shadowing a particular physician, staff member or gaining a clinical skill set for my education.

True

False

Question Title

* 13. I will accept that part of my volunteer experience includes wiping down and sanitizing toys and equipment to help maintain infection prevention standards and keep kids and everyone in the hospital environment safe.

Yes

No

Question Title

* 14. Do you have any relatives that work for UPMC Children's Hospital of Pittsburgh?

Yes

No

If you answered YES, please provide relative(s) name.