Thank you for your interest in our Galaxy 51 Program. Application requires the completion of the online application below in its entirety.
Fields marked with an asterisk are mandatory.
*First name:
*Last name:
Middle name:
Nickname:
*Street address:
*City:
*State:
*Zip code:
Home phone: (e.g. 215-590-0000)
Work phone: (e.g. 215-590-0000)
Cell phone: (e.g. 215-590-0000)
*Email address:
*Email address re-entry (for validation purposes):
*Date of birth:
Languages spoken:
*I am currently enrolled in a college program full-time:
Yes
No
*Education experience:
high school
some college
college degree
graduate degree
Employer:
Position:
Availability:
Monday mid-morning to afternoon
Monday afternoon to 6pm
Tuesday mid-morning to afternoon
Tuesday afternoon to 7pm
Wednesday mid-morning to afternoon
Wednesday afternoon to 6pm
Thursday mid-morning to afternoon
Thursday afternoon to 7pm
Friday mid-morning to afternoon
Friday afternoon to 6pm
*Primary phone:
Alternate phone:
Relationship:
Are you a current CHOP employee?
Have you ever been employed at CHOP?
yes
no
If yes, reason for leaving
Is any family member a CHOP employee?
If yes, name of family member
Please list any past or current volunteer experience (organization, duties, & service dates)
How did you learn about our Volunteer Program?
CHOP website
CHOP employee/volunteer
School/College
Other
*Why are you interested in volunteering at CHOP?
Please describe your experience working with children, including your own.
Please share with us any additional information about special skills you may have.
*First Name:
*Last Name:
*Street Address:
*City, State, Zip Code:
*Relationship:
*
I certify that the information provided on this application is true and complete to the best of my knowledge, and agree that falsified information or significant omissions may disqualify me from further consideration from volunteering and, if I am accepted to be a volunteer, will result in my dismissal when discovered. I understand that, if accepted as a volunteer, I will be required to abide by all the policies, rules and regulations of the Hospital. I authorize the Hospital to investigate all statements contained in this application and to make inquiries of my personal references and medical history, as well as other related matters as may be necessary for arriving at a decision of acceptance into the volunteer program. I hereby release employers, schools or individuals from all liability in responding to inquiries relative to my volunteer application.
If accepted into the volunteer program, I agree that I will attend all scheduled training sessions in their entirety.
I Agree
Did you know your employer may match your volunteer hours with a monetary gift to CHOP? Learn more.
