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LGH Volunteers Registration Form
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Once you complete this form you will receive email confirmation of your submission.
Your Information
Email Address
First Name
Middle Name
Last Name
Nickname
Maiden Name
Suffix (Jr., Sr., MD, PhD, RN, etc.)
Home Address Line 1
Home Address Line 2
City
State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
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TN
TX
UT
VT
VA
WA
WV
WI
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Zip Code
Phone
College you are currently enrolled
Please select...
College of Education
College of Fine Arts, Humanities and Social Sciences
Francis College of Engineering
Kennedy School of Sciences
Manning School of Business
Zuckerberg College of Health Sciences
University contact who referred you (if applicable)
First Name
Last Name
Email Address
Volunteer Information
Volunteer Roles you are willing to help with (check all that apply. Some shifts may require volunteers to serve more than one role).
Greeter/Usher: Help with parking lot assistance, line control, check out process and monitoring of the post vaccination area. Guide patients through the various vaccine clinic areas and may assist with wheelchairs and transport through the clinic as needed.
Registrar: Assist with patient registration and check in process. Must be familiar and comfortable with computer systems and with data entry. Also have good attention to detail.
Phone Assistant: Monitor and answer calls and questions that come into the Vaccine Clinic. Must have strong customer service and communication skills.
Vaccine Prep & Vaccinator: Assist in the prep and administration of the vaccine. This position is restricted to medical professionals and can include any of the following: Nurse Practitioner, Registered Nurse, Licensed Practical Nurse, Nursing Assistant, Physician Assistant, Advanced Practitioner Registered Nurse, Pharmacist, Medical Assistant, and Emergency Medical Technician.
Brief description of license, certification, etc.
Availability
Hours/Days you are available (please check all that apply during spring semester)
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Available Sunday Hours (select all that applies)
7:00 am - 3:30pm
12:00pm - 5:00pm
3:00pm - 7:00pm
Available Monday Hours (select all that applies)
7:00 am - 3:30pm
12:00pm - 5:00pm
3:00pm - 7:00pm
Available Tuesday Hours (select all that applies)
7:00 am - 3:30pm
12:00pm - 5:00pm
3:00pm - 7:00pm
Available Wednesday Hours (select all that applies)
7:00 am - 3:30pm
12:00pm - 5:00pm
3:00pm - 7:00pm
Available Thursday Hours (select all that applies)
7:00 am - 3:30pm
12:00pm - 5:00pm
3:00pm - 7:00pm
Available Friday Hours (select all that applies)
7:00 am - 3:30pm
12:00pm - 5:00pm
3:00pm - 7:00pm
Available Saturday Hours (select all that applies)
7:00 am - 3:30pm
12:00pm - 5:00pm
3:00pm - 7:00pm
Is there any other information you would like to share? (i.e., alumni, professor emeritus, retired staff, fluency in languages and can provide interpreter services, other qualifications?)
