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Volunteer at Dana-Farber

Application for Volunteer Services

To apply for a volunteer postition at Dana-Farber, please fill out the form below. A Volunteer Services staff member will contact you soon.

Items in BOLD are required.


Your Information
 
Salutation:
First Name:
Last Name:

Date of Birth:
Street Address:
Street Address 2:
City:
State:

Zip Code:
Home Phone:
Work Phone:
Extension:
Cell Phone:
E-Mail Address:

Are you 18 years of age or older?
Availability
 
Volunteer shifts are available Monday - Friday from 7:00 am to 5:00 pm only.
*We do not do single-day or corporate volunteer opportunities.
Can commit four hours per week for six months:
Please specify which days and times you are available. You must enter hours for at least one day.
Monday - from:
  to:  
Tuesday - from:
  to:  
Wednesday - from:
  to:  
Thursday - from:
  to:  
Friday - from:
  to:  
How long do you anticipate being able to volunteer at Dana-Farber? Please describe any breaks in your commitment:

Motivation

Please tell us why you want to volunteer at Dana-Farber. Be as specific as possible and include:

  • Characteristics and skills you possess that would benefit Dana-Farber
  • What placement is of interest to you and why
  • Whether you have worked with patients and families before, and what you found rewarding and challenging about the experience

Is there anything you would not want to be part of?


Education - fill in all sections that apply
High School 
Name:
City, State:
Dates:
Did you graduate?
Undergraduate Degree 
Name:
City, State:
Dates:
Major:
Did you graduate?
Other 
Name:
City, State:
Dates:
Degree or certificate:
Are you currently a student?
If yes, where:
Employment Information - This section must be completed with all information

 
Employment Status

Current/Recent Employer  
Company Name:
Position:
Dates Employed:
Supervisor's Name:
Supervisor's Phone:
Address:
Additional Current/Recent Employer
Company Name:
Position:
Dates Employed:
Supervisor's Name:
Supervisor's Phone:
Address:
At Dana-Farber
 
Have you ever worked or volunteered at Dana-Farber?
Dates:
Position:
Department:
Supervisor:
Reason for Leaving:
References
 
No relatives please. Students should list an advisory or faculty member for one of the references.
Reference 1 
Name:

Relationship:

Company/Institution:
E-mail:
Street:

City:

State:

Zip Code:

Volunteer Experience
 
Most Recent Position 
Start/End Dates:
Agency or Affiliation:
Duties Completed:
Previous Position 
Start/End Dates:
Agency or Affiliation:
Duties Completed:
Prior Convictions
Please read this carefully before answering.

You may answer "No" only if you have no criminal record OR your criminal record consists of one or more of the following:

  1. A sealed record on file with the commissioner of Probation
  2. Your case is a case where you were determined to be delinquent or to be a child in need of services, which did not result in a complaint transferred to Superior Court for criminal prosecution or
  3. Your crimes were misdemeanors and they occurred five or more years ago.

Note: A conviction record will not necessarily be a bar to volunteer service.

Have you been convicted of a felony or misdemeanor?
Terms of Application
I certify that the statements made in the volunteer application are true and correct, and have been given voluntarily. I understand that I will not be paid for my services as a volunteer. I further understand that I may be asked to discontinue my volunteer services at any time for any reason.

I agree to abide by the guidelines of Volunteer Services, to respect patient confidentiality, and uphold the traditions and standards of Dana-Farber Cancer Institute, including abiding the Smoke-Free Workplace Policies, Agreement on Professional Behavior, Substance Abuse Policy and Invention Agreement.

Volunteers will demonstrate a readiness to help others, maintain healthy boundaries and assist patients through their cancer journey.

I understand that volunteer service will be contingent upon approval from the Volunteer Services and Occupational Health Departments. Volunteer service is also contingent upon satisfactory results of a background check, including a criminal record check. The results of the checks will be treated as highly confidential.

   I agree
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