Summer Junior Application (SL)

HARRIS HEALTH SYSTEM

Requested site: Please select ONE (1) preferred location: Ambulatory Care Services (Clinics), Ben Taub Hospital, or LBJ Hospital. All locations will be filled on a 'first come, first served' basis. If your preferred location is no longer available, you may be offered another option.

STUDENT CONTACT INFORMATION

*Are you a returning volunteer?

Please Select

Gender

Name prefix

* First Name

MI

* Last Name

* Date of Birth

* Home Address

* City

* State

* Zip Code

* Primary Phone

* Student Email Address

* SSN

Shirt Size

Language

Additional languages

Ethnicity

Volunteer source

Please list friends or realtives employed by Harris Health:

If applicable, please provide us with the employee's facility or physical work location:

PARENT/GUARDIAN CONTACT INFORMATION

**Please Note: Parent/Guardian Consent Form is required and available to download HERE. You will be required to upload it at the end of this application.

* Parent / Legal Guardian Name

* Relationship to Junior Applicant

* Primary Phone

* Parent/Legal Guardian E-mail Address

* Home Address

* City

* State

* Zip Code

STUDENT EDUCATION INFORMATION

* High School

* Grade Entering in Fall

* GPA:

Career Plans/Interests:

Clubs/Teams or Memberships:

2024 JUNIOR PROGRAM INFORMATION

** Please Note: A Volunteer Agreement Form is required and is available to download above. You will be required to upload it at the end of this application

APPLICANT SHORT ANSWER: Each student is required to provide responses to the questions below.

* 1. Describe a situation in which you had to be creative. What did you find challenging or exciting about.

* 2. Is there anything else you would like us to know about you?

DOCUMENT UPLOADS

Please upload your REQUIRED DOCUMENTS below.

Please upload your Junior Volunteer Agreement & Parental Consent Forms:  This online application will not be processed without required agreement & consent forms.

Click here for Agreement & Parent Consent Form

* By checking this box, I understand and agree to the requirements of the Summer Junior Program. I have submitted all required documentation or will return to log-in and upload it. Failure to upload/receive required documentation by May 1, 2024 may disqualify this online application.

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Please use your mouse or your finger to sign: