COLLEGE STUDENT SUMMER PROGRAM APPLICATION Age: Date of Birth:

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1 Volunteer Services Department COLLEGE STUDENT SUMMER PROGRAM APPLICATION Name: (Last) (First) (Middle) Date: Address: (Street) (City) (State) (Zip Code) Phone: (H) (C) Age: Date of Birth: *Parent/Guardian s *Please provide this information if you are under 18 years old Previous Volunteer Experience: Do you have a relative who is employed at the Cleveland Clinic? Yes No Name Department Relationship Volunteers are not permitted to volunteer in an area or department where a relative is employed. The completed College Student Summer Program Application and Personal Interest Form must be submitted to reinkej@ccf.org by May 20, 2016 at 5:00 p.m. in order to be considered for the program. Applicant Signature: Date: (Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age, or gender.)

2 Volunteer Services POLICIES COLLEGE STUDENT SUMMER PROGRAM AFTER RECEIPT OF YOUR FULLY COMPLETED APPLICATION AND PERSONAL INTEREST FORM there are three basic steps towards placement as a Cleveland Clinic Summer College Student Volunteer: Attend one INFORMATION SESSION; Complete SILK ROAD ONLINE ONBOARDING; Attend one ORIENTATION SESSION before officially starting to volunteer. Step One: Information Session: Based on your Application and Personal Interest Form, you ll be invited to attend an Information Session where you will learn more about the program! Information Sessions for Summer College Student Volunteers: Wednesday, May 25 th 9:00 a.m. 11:00 a.m. Thursday, June 2 nd 9:30 a.m. 11:30 a.m. Wednesday, June 8 th 9:00 a.m. 11:00 a.m. Step Two: Silk Road Onboarding: After the Information Session, you will be offered an opportunity to pursue a summer volunteer assignment based on your availability; readiness for volunteer service, and ability to make a clear commitment. Silk Road onboarding instructions will be ed to the applicant upon acceptance. Step Three: Orientation Session Incoming volunteers are required to attend Orientation Session prior to receiving a Cleveland Clinic badge and starting an assignment. Cleveland Clinic Volunteer Services policies and hospital-wide policies are presented. Mandatory additional training is required for some assignments including Inpatient Nursing Units and Cleveland Clinic Children s. Orientation Sessions for Summer College Student Volunteers: Wednesday, June 1 st 10:30 a.m. 12:30 p.m. Thursday, June 9 th 10:30 a.m. 12:30 p.m. 2. All Summer College Student Volunteers are required to complete 75 hours of volunteer service during their summer. Before accepting a volunteer assignment, please be realistic about your ability to commit to a set schedule.

3 3. Summer College Student Volunteers will plan their required number of weekly hours with their coordinator to fulfill the 75 hour requirement. On average, Summer College Student Volunteers will contribute eight (2) ten (10) hours over the course of two days per week. Shifts will range between four and five hours per day. 4. Schedules (day and/or time) cannot be changed due to vacations; summer jobs; or any other conflicts that arise during the course of your summer. 5. A Summer College Student may have one (1) unplanned/unanticipated one-day absence from the program. Upon a second unplanned/unanticipated absence of one day (or longer) it is then at the coordinator s discretion if continuation with the program will be permitted. 6. A letter verifying participation in the program, including the number of hours completed, will be generated only for Summer College Student Volunteers who have completed 75 hours of volunteer service. Volunteer Services does not provide letters of reference. 7. Applicants seeking to earn college credit through their respective universities must inform their coordinator prior to the start of the program that college credit is sought. 8. For security purposes and for purposes of identification, Volunteers are expected to wear and prominently display their identification badges while on the clinic campus. The badge is to be worn above the waist with the photograph facing out. Stickers and pins may not be affixed to the badge. The volunteer uniform must be worn at all times during the shift. DRESS CODE A professional appearance is required in Cleveland Clinic s professional environment. Inappropriate, casual attire is not permitted, including but not limited to: jeans, sweat pants, sweatshirts, yoga pants, T-shirts, shorts, capris, cropped and low cut tops, and mini-skirts. Shoes must be clean and in good condition, and the laces must be tied. Sandals, flipflops, moccasins, boots, platforms, and high-heeled shoes are not to be worn, since they may increase the risk of injury. Open toe shoes and sling backs are also are prohibited. Jewelry must be conservative and kept to a minimum, with avoidance of large, dangling earrings and other large, dangling jewelry. Females may wear one pair of simple post earrings. Males are prohibited from wearing earrings. Body piercing jewelry is a violation of the Dress Code policy. Hair is required to be a natural color. Fragrance is not to be worn when coming to campus for a volunteer shift.

4 Volunteer Services College Student Summer Program Personal Interest Form Name: School: Date Assignments: Which of the following types of duties would be of most interest to you? (Mark ALL that apply.) Greeting and escorting patients Provide support and service for patients and employees in outpatient areas Provide support and service for inpatients and nursing employees on nursing units Opportunities with Cleveland Clinic Children s and/or pediatric outpatient areas Provide support and service for patients and employees at a Family Health Center Please indicate Family Health Center location Provide clerical assistance (filing, copying, making phone calls, data entry, etc.) Other areas of interest III. Availability: NOTE: A contribution of at least 75 hours is required to successfully complete the program. How many days/hours per week do you plan to commit to volunteering? PLEASE INDICATE YOUR AVAILABILITY: HOURS MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY Morning Afternoon Evening List date(s) and reason(s) why you will not be able to volunteer or would anticipate schedule changes (summer classes; summer employment; vacations, etc.): IV. Provide three reasons why you would like to be a College Student Summer Volunteer at Cleveland Clinic: (1) (2) (3)

5 College Student Summer Program Personal Interest Form (continued) V. What does the phrase Patient Experience mean to you? VI. What skills and/or qualities would you bring to the program?