Volunteer Placement Request Form

Please Enter Your Information:
Please complete all fields.
Requestor's Name:
Requestor's Job Title:
Requestor's Hospital Department:
Office Phone:
Work Email:
Volunteer Support Location:
Is this volunteer's primary role: Administrative/Clerical Patient Contact Research Other
Is this assignment: Ongoing Short-Term If Short-Term, Expected End Date:
Total Volunteer Hours Needed Weekly: (please include any current volunteers)
Minimum Qualifications:

Preferred Competencies: (Please list any special skills required. i.e. Meditech, Athena, language skills)

Days & Times Service Needed
Monday	Times: thru
Tuesday	Times: thru
Wednesday	Times: thru
Thursday	Times: thru
Friday	Times: thru
Saturday	Times: thru
Sunday	Times: thru
Volunteers are assigned to provide ancillary support to patients and visitors under the supervised guidance of hospital administrators, patient care personnel, and support staff. Questions regarding volunteer responsibilities can be directed to Volunteer Services at 617-789-2334.

Additional Comments: (Please include any other details about the position not listed above, including if you already have identified a candidate or candidates to fill this position)

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