Emory Clinic Volunteer Program Department Request Form
Thank you for your interest in wanting to request an Emory Clinic Volunteer. We are working to improve our volunteer program to meet your needs. In order to provide you with the assistance you need, we are asking you to fill out the following form. Our Volunteer Program Coordinator will then work to match your request with volunteers, as available, and follow up with you.

If you have any further questions, please feel free to contact us at emoryclinicvolunteers@emoryhealthcare.org.

1. Name of Department
Your answer
2. Location of Department (Please include address and floor)
Your answer
3. Name of Contact Person
Your answer
4. Phone Number of Contact Person
Your answer
5. When would you like a volunteer to come assist your department?
Morning
Afternoon
All Day
Monday
Tuesday
Wednesday
Thursday
Friday
6. Task: How would you like our volunteers to help your department?
Your answer
7. Will our volunteers need computer access, in order to fulfill the task you are requesting?
8. Personality Type: What personality works best with the task you are requesting?
Your answer
9. How many volunteers would you like to have for each day requested? Please be specific. If you have listed more than one task, please include how many volunteers are needed for each task.
Your answer
10. Any Additional Information?
Your answer
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