SUMMER 2016 VOLUNTEEN PROGRAM

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1 SUMMER 2016 VOLUNTEEN PROGRAM Thank you for your interest in our Summer VolunTEEN Program at Doctors Hospital at Renaissance. The VolunTEEN Program exists to provide excellent service to our patients, their families, and hospital staff. It will also introduce you to many opportunities in a professional work environment. Before filling out an application, please keep in mind that eligible applicants must: Be between the age of 15 and 18 as of June 13, Be willing to fully commit to our 8 week program. The program will run from June 13 th - August 7 th. Be able to serve at least 8 hours per week during the summer. A commitment of at least 60 total hours is required. Complete a 500-word essay, stating your reason(s) for volunteering. Attend a mandatory group interview with Volunteer Services. Complete and pass a health screening and TB test. Attend a three-hour orientation day on either Saturday, May 28 th or Sunday, May 29 th. It is also worth noting that the attendance in the program is VERY important. If you plan to be away this summer for more than two weeks, this program is not for you. In return for your dependability, you will be able to spend the summer with friends learning about various careers in the hospital setting, establishing your resume, and fulfilling any community service requirements you may have. Please keep in mind that applications are due in full no later than Friday, April 8, The staff of the Volunteer Services Department will only evaluate complete application packets that meet the deadline. Please be mindful that there is a selection process. Due to limited site placements we will not be able to accept every applicant. I am very excited for the 2016 VolunTEEN Program to begin, and hope you are too. It is bound to be another great year of friends and fun, and I can t wait to meet the new additions to our volunteer family! Should you have any questions, please feel free to contact me at (956) or via at c.esparza@dhr-rgv.com. Thank you, Cristie Esparza Volunteer Services Manager 5501 S. McColl Road Edinburg, Texas Post Office Box 3293 McAllen, Texas Telephone: (956) Fax: (956) c.esparza@dhr-rgv.com

2 Student Name: SUMMER VOLUNTEEN PACKET CHECKLIST Please ensure that the following portions of the Summer VolunTEEN application packet are complete before returning the application packet to the Volunteer Services Office. Applications that are incomplete will not be processed. Please return this checklist with the Summer VolunTEEN Application packet. Summer VolunTEEN Application Please ensure that all fields are filled out. Student Essay Additional details are listed on the application. Reference Form Must be completed and placed in a sealed envelope. Unsealed reference forms will not be accepted. This form will be submitted with the application packet. Summer VolunTEEN Requirements Carefully read over each requirement for the Summer Program. Immunization Record Records may be obtained through a family physician or school nurse. Copy of Photo ID Driver's License, School ID, or other form of photo identification DO NOT WRITE BELOW THIS LINE For Office Use Only Received Date: Applicant Meets Requirements for Interview Applicant Does Not Meet Requirements for Interview Missing Items:

3 SUMMER VOLUNTEEN PROGRAM APPLICATION Full Name: Home Address: City: State: Zip: Cell: ( ) - Home: ( ) - Preferred Contact: Phone Text Address: Date of Birth: / / High School: Grade Level: 9th 10th 11th 12th Are you currently employed?: Yes No Employer: Name/Relationship Contact Number EMERGENCY CONTACT INFORMATION Previous volunteer experience: List special interests, hobbies, skills: How did you hear about our VolunTEEN Program? Friend Media Ad School Parent Are you related to or do you know any employee or volunteer of DHR? Yes No Name: Relationship: Dept.: BACKGROUND CHECK We consider the safety and security of our patients to be of the utmost importance. We will conduct at our cost a criminal background check with state and/or federal agencies. Social Security Number: - - Have you ever been convicted of or been on deferred adjudication for, or are now either awaiting trial for or on deferred adjudication for, a felony or misdemeanor? Yes No If yes, describe in full, including dates and locations. STUDENT ESSAY REQUIREMENTS Students must write and submit a 500-word essay. Please tell us about yourself and why you should be considered for a volunteer position at DHR. Topics to discuss might include extra-curricular activities, academic achievements, community service experiences, future goals, etc. The essay may be typed or printed and must be attached to the application.

4 SUMMER VOLUNTEEN REQUIREMENTS 1. Age: High school students must be at least 15 years of age to volunteer. 2. Recommendation: VolunTEENs must submit the attached VolunTEEN Recommendation Form from a teacher or school staff member in a sealed envelope. 3. Interview: Applicants will be contacted via to schedule an interview. 4. Orientation and Training: All VolunTEENs are required to successfully complete the orientation and training classes as outlined during the interview. 5. Commitment: VolunTEENs are asked to commit to a minimum of 60 hours during the program. 6. Willingness: VolunTEENs should have a sincere desire to perform a community service and be helpful in any area where assigned. 7. Responsibility: VolunTEENs should have a genuine sense of responsibility to the hospital. VolunTEENs will follow the specific guidelines, which will be discussed at orientation. 8. Dependability: VolunTEENs are expected to be faithful in attendance, giving notice of planned absences in advance and notifying the Volunteer Office of an emergency absence. Excessive or unexcused absences may result in immediate dismissal from the program. 9. Uniform: VolunTEENs take pride in appearance. All VolunTEENs must wear their hospital issued I.D. badge and uniform at all times. Required uniform polos are available to purchase for $20. The polo is to be worn with khaki bottoms and closed-toe shoes. Jeans, shorts, and sandals are NOT permitted. 10. Transportation: VolunTEENs must arrange and provide their own transportation during service. location. 11. Health Requirements: Students will need to submit a copy of their immunization record along with the completed application. Records may be obtained through a family physician or school health department (Nurse s Office). Upon clearance, a TB skin test & drug screen will be administered. These tests are available at DHR without cost. 12. Background Check: Both a photo ID and social security number are required. I have read the above requirements, understand them, and wish to apply to be a VolunTEEN at Doctors Hospital at Renaissance. VolunTEEN s Signature: Date: I have read the above information and give my permission for the applicant to become a VolunTEEN at Doctors Hospital at Renaissance. Parent s/guardian s Signature: Date: Application must be submitted either in person or by mail to: Doctors Hospital at Renaissance - Del Prado Support Services Building Volunteer Services Department Attn: Cristie Esparza 101 Paseo Del Prado, Edinburg, TX 78539

5 VOLUNTEEN RECOMMENDATION FORM The following individual has applied to be a volunteer at Doctors Hospital at Renaissance Health System and has selected you as a personal reference. **Please complete this form, place it in a sealed envelope, and return the envelope to the candidate.** To be completed by the Applicant: Name: Date: To be completed by the Personal Reference: Name: Title/Position: Best Contact Phone: Address: Please grade the Applicant by checking the appropriate box for each of the areas indicated here. Leadership Teamwork Listening Skills Articulation (ability to communicate ideas clearly) Dependable/Reliable Personality Awareness of/and enthusiasm for the program Excellent Good Fair Needs Improvement How long have you known this applicant and in what capacity? Please use this space to add additional comments or recommendation. Overall Recommendation: Recommend Do NOT Recommend Signature of Personal Reference Date