Returning AIM Volunteer Information Form

Please fill out the following form to the best of your ability. If you have any questions, please contact us at MOSSSA@shands.ufl.edu or call us at (352)-733-0880.

"*" indicates required fields

Name*

First Last

Phone*

Email*

Department/Major*

Expected Career Path*

Are you over the age of 18?*

Yes

Are you volunteering for class credit?*

Yes

If yes, please indicate

Course Title

# of hours to be completed by end of term

Please select your FIRST choice for placement from the drop down menu*

If your selection is a Music discipline or Supply Chain, please indicate the days/times in which you are available for a 1 hour shift

Please select your SECOND choice for placement from the drop down menu*

If your selection is a Music discipline or Supply Chain, please indicate the days/times in which you are available for a 1 hour shift

Please select your THIRD choice for placement from the drop down menu*

If your selection is a Music discipline or Supply Chain, please indicate the days/times in which you are available for a 1 hour shift

Please briefly describe your expectations for your volunteer experience with us.*

Describe your experience, background and skill level in the arts discipline in which you are applying*

Anything else you would like us to know? (e.g. Are you in the Center for Arts in Medicine certificate program? Do you have a strong preference to work with pediatric patients, are you bilingual?, etc.)