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.

Name*
First Last
Phone*
Email*
Department/Major*
Expected Career Path*
Are you over the age of 18?*
- Yes
- No
Are you volunteering for class credit?*
- Yes
- No
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, please indicate the days/times in which you are available for a 30min-1hour shift
Please select your SECOND choice for placement from the drop down menu*
If your selection is a Music discipline, please indicate the days/times in which you are available for a 30min-1hour shift
Please select your THIRD choice for placement from the drop down menu*
If your selection is a Music discipline, please indicate the days/times in which you are available for a 30min-1hour 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.)

Course Title	# of hours to be completed by end of term