Athena Pre-Med Hospice Application
Name:
School: University of Pittsburgh
Name of Hospice: Anova Hospice
Phone #:
Email Address:
Expected Graduation Year:
Intend to go to Medical School:
I will complete clearances and the TB test: ______ (Initial)
I will complete training for end of life issues: ______(Initial)
I will complete Prompt assignments as described in the Pre-Med Hospice Intro: _____(Initial)
I will attend monthly meetings as described Pre-Med Hospice Intro: ACCL: ____(Initial)
I will complete year-end essay:______________________ (Signature)
Why would you like to be an Athena Institute Pre-Med Hospice Volunteer (3-4 sentences):
Name this application as follows: your name_2026_school name.