CSHC Volunteer Application Form
Thank you for your interest in volunteering with Columbus Speech & Hearing Center! Please complete the form below. We will contact you if we have a volunteer opening that matches your interests and hours of availability.

It is the policy of Columbus Speech & Hearing Center that no person shall be discriminated against on the basis of disability in admission or access to, or treatment or employment in, its programs and activities.
Email address *
Today's Date *
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Your Birthdate *
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First Name *
Last Name *
Address *
Phone Number *
Are you a student? *
If yes, please indicate your current enrollment status
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If yes, please indicate your expected graduation date
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Employer *
Employer Address
Employer Phone Number
Occupation/Title *
How did you hear about volunteer opportunities at Columbus Speech & Hearing Center? *
Why would you like to volunteer at Columbus Speech & Hearing Center? *
Please list previous experience (volunteer, paid, or educational) that would be helpful in your volunteer work:
Is there a specific area/kind of task you are interested in helping with?
Do you have experience working with the Deaf or Hard-of-Hearing? *
Do you know American Sign Language (ASL)? *
What types of computer software are you familiar with?
Do you have knowledge of another language in which you could assist with some simple interpreting? *
If so, what language(s)?
How many hours a week would you like to volunteer? *
Please specify your days and hours of availability: *
Is it necessary to limit your physical activity in any way? *
Do you have personal transportation? *
Please list the name, relationship, and phone number of an emergency contact. *
510 E. North Broadway | Columbus, OH 43214
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