Emergency Department Research Assistant Application Form

*Required fields (required format)

Personal Information

Prior Affiliation with SUNY Upstate:
         If Yes,
Emergency Contact

Employment Information
Are you: (please check all that apply)

Education/Training Information

Previous Health-Related Experience

Were you paid?
Were you a volunteer?

Were you paid?
Were you a volunteer?

Were you paid?
Were you a volunteer?

Recommendations*Please provide the contact information for two non-family members who can discuss your suitability to volunteer in a hospital setting. We will send them a letter of recommendation form via email attachment to complete.

Required Attachments*Essay:
*Curriculum Vitae: Please attach/upload your Curriculum Vitae (MS Word or PDF):

I submit my name for consideration to volunteer at University Hospital. I understand that, ideally my association as a volunteer will extend far into the future, but a commitment of at least 100 hours is expected during the first 6 months of service. In addition, the college volunteer program is based on a per semester basis and requires a 50 hour commitment per semester.

This question is to prevent automated spam submissions.
Math question: *
Solve this simple math problem and select the answer.
E.g. for 1 + 3, select 4.