(to help us pair you with patients - ex: music, fishing, travel, sewing, art, photography, etc)
List three references. You may use any professional, academic, peer, or community individuals who can tell us about your character and skills. You may use one relative.
I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that, by submitting this application I authorize inquiries to be made concerning my employment, character and public records for the purpose of determining my suitability as a volunteer.
