Terence Cardinal Cooke "At Your Service" Program Interest Form
If you are interested in volunteering with the Terence Cardinal Cooke "At Your Service" Program for the Spring 2016 semester, please answer the questions below ASAP.

**As Soon As Possible: Please copy and paste the link below to our Google Document that contains the Spring 2016 Volunteer Registration packet. A delay in completing these requirements will delay your ability to volunteer.

**Spring 2016 GETTING STARTED CHECKLIST & VOLUNTEER APPLICATION** (Copy/paste into address box):
https://drive.google.com/file/d/0B4nZmjM9pScKWE9VeU5jUl9FYjg/view

*Please note that we are currently in the process of updating our application for the Spring 2016 semester, but you may still use the above application as all the information still applies for the upcoming semester.

To submit the volunteer application, scan it in as a PDF and send it to tcc.atyourservice@gmail.com, or notify us at tcc.atyourservice@gmail.com and we'll arrange a time for you to submit a hard copy to us. If you don't have access to a scanner, a good free smartphone app for converting photos to PDFs is CamScanner. When you submit your application, please also email us a photo of your ID -- Columbia ID is fine, and your ID does not have to be scanned.

If you have questions or want to learn more about past volunteer experiences, visit our website at http://cssrtcc.wordpress.com/at-your-service-volunteer-program/ and read volunteer reflections at http://cssrtcc.wordpress.com/at-your-service-volunteer-program/volunteer-reflections/ or e-mail our Coordinators at tcc.atyourservice@gmail.com.

*NOTE: A question below asks you for information about your immunization records in regard to a TCC Volunteer Requirement. This information may be located in your Columbia University immunizations record on file, which you can access by visiting https://secure.health.columbia.edu, logging in with your UNI, and clicking "Immunizations" on the left side bar. Many volunteers contact previous health providers (i.e. pediatrician or family doctor in their home town) to get the information required. You may edit your responses to this form at a later time if you are unable to obtain the information right now.
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Full Name *
Preferred E-mail Address *
Cell Phone Number *
Class Year *
School *
(i.e. Columbia College, Barnard College, SEAS, General Studies, Continuing Education, CUMC, etc.)
Please check ALL shifts during which you could volunteer. *
Shifts will be assigned to volunteers by the Volunteer Coordinators.
Required
Please select your shift scheduling preference. *
After retrieving my personal immunizations record, I have confirmed that my Varicella (chicken pox) immunization status is the following: *
Log in with your UNI at health.columbia.edu to retrieve your Columbia immunizations record online. Volunteers often contact their previous health care providers (i.e. pediatricians) to retrieve old immunizations records.
A mandatory "At Your Service Program" Orientation will be held prior to the start of shifts. We will have more information on the date later. You must be able to attend for the entire session, or a make-up session.
Terence Cardinal Cooke is located at 1249 Fifth Avenue between 105th St. and 106th St. If you are unsure of your availability, please choose "Other" and state your potential conflict.
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Is there anything else you would like us to know?
Do you have a special talent you can share with our residents, i.e. play an instrument, make balloon animals, etc.? Is there a certain patient population you would like to work with (Geriatrics, HIV/AIDS, Huntington's Disease, Palliative Care/Hospice Care?)
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