Volunteer Database Form | Emerge Pediatric Therapy

Date*

Name*

First Last

I am interested in:*

the Volunteer Database

I am interested in:*

Occupational Therapy
Speech-Language Therapy
Both
Undecided

Date of Birth*

MM

DD

YYYY

Phone*

Email*

Enter Email Confirm Email

University*

(Please indicate the current university you are attending. If you are not currently enrolled, please indicate either your most recently attended school or where you are planning to attend in the future.)

Major*

Year in School*

(Enter your current year in school. If you are not in school, please indicate the number of years of education you have completed.)

How did you hear about Emerge?*

Please tell us a little about yourself:*

Why are you interested in volunteering at Emerge?

Please share your availability for an initial interview:*

Prior to being added to the Database you will need to complete an interview. This consists of coming into the clinic, meeting with one (or several) therapists, shadowing some sessions, and learning more about clinic expectation for volunteers. The times below are loose times. You will work with the coordinator on selecting a more specific times to come into the clinic.

Volunteer Database Application

Fill Out the Volunteer Database Application

Volunteer Database Application Form