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Volunteer Application

Centra is honored to have hundreds of volunteers from throughout our service area making a difference to our patients, visitors and staff.

We are always in need of more.

If you would like to volunteer at any of our facilities, please fill out the online application below. Be sure to select the facility in which you would like to serve. Thank you for your interest in our program. We look forward to hearing from you.

Volunteer Application

Privacy Policy

Centra Health is committed to respecting and protecting your privacy as a visitor to our Web site. We take the issue of privacy very seriously and value the trust you place in us each time you use our services and access this Web site. Click here to review Centra's privacy policy.

Your Personal Information

First Name *
Middle Initial
Last Name *
E-mail Address
Street Address *
City *
State *
Zipcode *
Home Phone *
Cell Phone
Work Phone
Date of Birth (M/D/Y) *
Last 4 digits of your social security number *
Have you ever been an employee at Centra *
Have you ever been convicted of a felony *
Education
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Employer
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Occupation
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Retired from
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Date of Last TB Skin Test
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Have you volunteered before
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If so, where
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Other organizations to which you belong
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Are you a member of Mended Hearts
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Spouse/Guardian Information

Name of Spouse or Parent/Guardian
Relationship
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Their phone number
Street Address
City
State
Zipcode

Personal Reference

Name of personal reference *
Their phone number *
Street Address *
City *
State *
Zipcode *

Emergency Contact

Emergency Contact Name *
Emergency Contact's Phone Number *
Street Address *
City *
State *
Zipcode *

Volunteer Details

Location to Volunteer *
Adult or Teen Volunteer *
Days of the week you are available







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Time(s) of the day you are available





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Skills





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Special Interests




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Available Start Date *

Confirm Your Application

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