Microsoft Word - VolunteersTraineesPoliciesUpdated.docx

Volunteer and Trainee Registration Form Request Form for Educational or Clinical Trainees or Volunteering (Updated: 02/25/2015) (All questions must be answered and a CV or resume attached. Use additional pages, if necessary)

Date : ________________________________ Name of Applicant: _____________________ Address : _______________________________

SSN : ________________________ Phone: _______________________

E-mail : _______________________ City: ___________ State: ____ Zip: ________ DOB : _______________________ Current Occupation/Education : ______________________________________________ Primary Supervisor : _______________________________________________________ Secondary Supervisor (if applicable): _________________________________________ Completely describe what you will be doing at SUNY (e.g., research activities, clinical observations, etc.) Please use a separate page if needed. If clinical observation or volunteering involves patient care, specifically indicate what activities will be performed. _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Proposed Total Numbers of Hours Per Week : _________ Proposed Days: _______ Proposed Dates From : _____________________________ To : __________________ Proposed Place of Activity On Campus : _____ ( Room #: _______); Off Campus : ___________________________

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