Sinai Together Volunteer Intake Form
Thank you for your interest in helping Sinai Together! You are making a difference.

As a reminder, we are an ad hoc student-run organization that has sprung up to fill a need in the community.

PLEASE READ: If you meet any of the following criteria, we are unable to partner with you at this time and we apologize.

- Experienced a fever in the past 2 weeks
- Experienced shortness of breath in the past 2 weeks
- Traveled to Europe, China, South Korea, Iran, California, etc. in the past 2 weeks
- Had contact with anyone diagnosed with COVID-19
- Have not had a background check as part of your current education program
- Are not fully immunized (standard immunizations + current influenza immunization)
Email address *
Please provide your full name. *
Email address *
Phone number *
Educational Program *
What NY areas are you able to service? (e.g. UES, Morningside Heights, Long Island City, etc.) *
Which services do you feel comfortable providing? *
Required
Would you be comfortable providing childcare in a home with the animals listed below? Please check if comfortable with that type of animal.
Is there a time of day that works better for you? Please check all that apply. *
Required
How many hours per day can you assist? *
Required
How many days per week can you assist? *
Required
Which days of the week are you available? Please check all you are available for, we will keep in mind how many days per week you have noted above. *
Required
If you are interested in helping out with Sinai Together Family Meals. (provide gourmet meals to healthcare professionals) what days are you available to deliver? *
Required
Do you have experience working with children?
Clear selection
If yes, please elaborate - Not a requirement, but helps us assess capabilities
Do you feel comfortable supervising infants 1-12 months?
Clear selection
Do you feel comfortable supervising children younger than school age (1 year to 5 years)?
Clear selection
Do you feel comfortable supervise children school age (6 years to 13 years)?
Clear selection
How many children would you feel comfortable supervising on your own at one time? Check all that apply.
Do you have experience supervising children with developmental disabilities?
Clear selection
If yes, please elaborate.
Do you feel comfortable supervising children with well managed chronic health conditions (eg: asthma, type 1 diabetes)?
Clear selection
PLEASE READ CAREFULLY - Clicking "I agree" constitutes an electronic signature, attesting that you understand and accept the conditions of participation. *
Captionless Image
Required
By checking this box, I am attesting that I have undergone a background check (through a workplace or past/present educational program) and am up-to-date on required vaccinations, including the annual influenza vaccine. *
Required
By checking this box, I understand and agree that I am voluntarily acting in my own individual capacity outside of any affiliation I may have with Mount Sinai. *
Required
Where did you hear about us from?
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Icahn School of Medicine at Mount Sinai. Report Abuse