Thank you for your interest in becoming a Gratitude Central volunteer with Novant Health Foundation! Please answer all questions below.

If you are looking for information regarding volunteering in one of our medical facilities, please visit Novant Health Volunteer Services .

Name and contact information

First name:

Middle:

Last name:

Preferred name/Nickname:

Phone number:

Email address:

Mailing address

Street address:

City

State

Zip code

Country

Date of birth

Date of birth:

Background

Highest level of education:

Current employment status:

Have you ever been employed by Novant Health?

YesNo

Provide location and approximate dates:

Have you ever been convicted of a crime?

YesNo

If yes or charges are pending, please explain:

Agreement

As a potential volunteer, I agree and acknowledge that the information I provide on this application or in any upcoming interviews is true. Any misrepresentation or omission of facts, or misleading or false information on my part will be grounds for non-acceptance into this program. I understand that volunteers represent and are a part of the Novant Health system, and are subject to all rules, regulations, and to proper authority.

Do you agree?

AgreeDisagree

Novant Health considers all applicants for volunteer placement without regard to race, color, religion, sex, national origin, age, disability, veteran’s status, marital status, sexual orientation, gender identity or expression.

Please contact Katie Boylan with any questions or if you need assistance.