Volunteer Placement Interview Checklist

You must bring this checklist, along with the required forms, to your placement interview. Volunteers missing required documents will not be placed.

For ALL Volunteers:

• Provide a copy of one (1) form of identity: Driver’s License, Social security card, valid passport, or birth certificate
• Signed copy of Volunteer Expectations (will be provided at orientation)
• Proof of Flu Vaccination (Required November – April)
• Signed Confidentiality form (will be provided at orientation)
• Signed Media Consent (will be provided at orientation)
• Certificate of Completion for HIPAA & Privacy (will be provided at orientation)
• Release of Background Check (will be provided at interview)
• Certificate of Completion for Good Samaritan Volunteer Orientation (will be provided at orientation)

Supplemental Forms (for Pet Therapy Volunteers ONLY):

• Copy of Dog’s Therapy Certification
• Copy of Dog’s immunization records 

Print Name: _____________________________________________

Name of Volunteer: _______________________________________

Relationship to Volunteer: _________________________________