Volunteer Application Form

Title:

First Name*:

Last Name*:

Street 1*:

Street 2:

City*:

State*:

ZIP*:

Primary phone:

( ) -

Email*:

Date of Birth*:

Today

References

List two people not related to you who can attest to your character. A personal reference cannot be one from a family member.

Relation status:

First Name*:

Last Name*:

Phone*:

( ) -

Relation status:

First Name*:

Last Name*:

Phone*:

( ) -

Commitment & Obligation

What length of commitment are you willing to make? (Note: We ask that you be willing to volunteer at least 4 hours per month and us at least a 6 month commitment.)

Will this volunteer position fulfill an obligation for community service or a school/church assignment? If so, How many hours are required for this assignment? (Note: We do not accept volunteers with court ordered community service.)

Choose Your BloodCenter*:

Please select the Versiti blood center you would like to volunteer at:

Wisconsin Locations:

Wisconsin Interests:

I Agree

Volunteer Application Form

References

Commitment & Obligation

Background Check – Authorization Waiver and Release Statement