BHCHP’s Volunteer/Internship Application

Please select which you are applying for

Volunteer Position Internship Program

  
Name Date
Address
City     State     Zip
Phone     Cell Daytime Evening
Date of Birth Female Male
E-mail *required

Whom to notify in case of emergency    

Name

Relationship     Phone
How did you hear about us?
Student Yes No School Major
Employed Yes No Occupation Employer
Retired Yes No Former Occupation
Prior Volunteer/Internship Experience (include dates)
Please describe any experience, special skills or area of interest that will help us determine where you might be best suited as a volunteer/intern for Boston Health Care for the Homeless Program.
What do you hope to gain from volunteering/interning with Boston Health Care for the Homeless?
Do you speak any languages other than English?

Expected Participation: Weekly Monthly As Needed

For internships only:     Fall Spring Summer

How many hours per week are you available?
Expected length of participation
Date you are available to start
Do you have a car? Yes No
Which days and hours are you available? Monday
 Tuesday
Wednesday
 Thursday
 Friday
 Saturday
 Sunday
Please check all of the volunteer/internship opportunities that interest you:
Foot Care in Medical Clinic
Waiting Room Hospitality
Leading group activities (art, movies, etc)
Research Support/ Conducting surveys of patients
Reception/ Front Desk Support
Office/Clerical Support
BHCHP’s most urgent need
Ethnicity (optional - for statistical purposes only)
White Black - African-American Hispanic - Latino Asian Native American
Other - please specify
*In addition to completing this application form, you must also submit two letters of reference from people who know you well (other than family). Emailed references will suffice. Email references may be sent to volunteer@bhchp.org.

**Further, volunteers & interns will also be required to complete the following: Orientation, CORI check, immunization records, any necessary training.

***Please note:  Our internship opportunities are customized based on the applicant’s interest, BHCHP’s needs, and open positions.  We will do our best to create an internship that is varied and meets your needs, but cannot always guarantee a position.

If you cannot complete this application on line, please feel free to fax to (857) 654-1096 or mail to:

Volunteer Programs
Boston Health Care for the Homeless Program
780 Albany Street
Boston, MA 02118