Diagnostic Medical Sonography Program printable pdf download

Diagnostic Medical Sonography Program

Volunteer Hours Form

Applicant/Volunteer Name (Please Print) ______________________________________________

Volunteer Healthcare Organization ___________________________________________________

This form documents that ______________________________________________ has completed volunteer (*)

hours with our organization ____________________________________________. These hours were

completed as listed below.

Hours per week ___________________

Date _______________________

Hours per month _________________

Date _______________________

Duties included: ________________________________________________________

_______________________________________________________________________

Supervisor name/Title ___________________________________________________

Address of Organization _________________________________________________

Contact information _____________________________________________________

Signature ______________________________________________________________

The previous information regarding my volunteer hours is accurate and valid.

Applicant signature ______________________________________ Date _____________________

(*) “Volunteer” hours are defined as time spent in a true volunteer status, where there was NO financial

compensation received by the applicant for any of the time that was spent volunteering. Verification of work

accomplished will be validated by Diagnostic Medical Sonography Admission committee. Feel free to attach

any additional documents.

Diagnostic Medical Sonography Program