Remote Volunteer Application

Thank you for your interest in volunteering remotely. Please make sure to save your password, as you will need to login to record your hours.

New User Details

User ID

User ID (verify)

Password

Password (verify)

Personal Information

* First or preferred Name

* Last Name

* Mailing Address

* City

* State

* Zip Code

* Cell Phone

Home Phone (if different)

* E-mail Address

* Date of Birth (mo/day/year)

* Please tell us what role you are applying for (example: card maker, remote data entry for oncology department, etc.)

* Please tell us why you are interested in volunteering remotely for BIDMC, and what you hope to accomplish or gain during your time as a volunteer?

In what languages are you proficient?

Optional - What is the highest level of education you have completed?

Current school/institution (if a student)

Expected graduation date (if a student)

Is there anything else you would like us to know (special talents, availability?)

To the best of your knowledge, are you eligible to work within all federal health care programs, state health care programs, and federal procurement or non-procurement programs?

Have you been excluded, suspended, debarred, or otherwise ineligible from working within any federal health care programs, state health care programs, or within federal procurement or non-procurement programs?

Optional - Upload a photo of yourself

* I Agree

Please sign your name by holding your right mouse button and moving it around to create your e-signature

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E-Signature