* 1. Name

* 2. Have you ever donated time to a community wellness event, a health care initiative or human service project?

* 3. Would you share your volunteerism with the Hospital and the community?

* 4. Please describe the type of service completed?

* 5. Where was the service provided?

* 6. Description of Tasks:

* 7. Can you estimate the time you spent on this effort?

* 8. How many of your family, associates or friends helped you with your efforts?

* 9. Can you estimate the time spent by your family, friends and associates on this effort?