1700 SW 7th Street, Topeka, Kansas 66606-1690      785-295-8000
St. Francis Health Center
 
 
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To complete the application process, the following will be needed.

A copy of your most recent grade report. (If it is the first semester of the school year and you have not yet received a grade report, send a copy of your grade report from the last 9 weeks of your previous school year.) This can be a computer generated report that you print from home.  
A letter of recommendation from a teacher or school counselor on school stationary. It may be hand written, but must be on school stationary.  An email reference letter is acceptable from their official school email address and may be sent to jordan.frost@sftks.net.   
All forms in this application packet completed. Your social security number will be needed when you are issued your i.d. badge. You do not need the card, but need to know the number.
Immunizations must be current for volunteers as well as employees.  Please send copies verifying TB, tetanus and MMR.  Hepatitis B series is not required if your volunteer position does not have potential of coming into contact with blood or bodily fluids.

Important:
The online application and other paperwork will not be processed without a copy of your grade report and a reference letter/email from a teacher or counselor.  (Exception is for volunteer positions from home.)


* Indicates required information
Last Name * 
First Name * 
Home Phone * 
Middle Initial 
Birthdate * 
Cell Phone 
Street Address 1 * 
Street Address 2 * 
City * 
State * 
Zip * 
Email Address 
School Name 
Father's Name 
Father's Home Phone 
Father's Work Phone 
Mother's Name 
Mother's Home Phone 
Mother's Work Phone 
Name of Guardian, If Not Living Wtih a Parent 
Guardian Home Phone 
Guardian Work Phone 
If we are unable to reach a parent in case of emergency, who would be our next contact person? 
Emergency Contact Name 
Emergency Contact Phone  
Emergency Contact Relationship 
Do you have a relative that is employed at St. Francis? If yes, write name, department and relationship: 
What do you hope to gain from your volunteer experience? 
Are you currently interested in a health-related career? 
If yes, what is yoru field of interest? 
Please indicate the best day of the week and hours (i.e. 4-8 p.m.) for your volunteer service 
Shirt Size (Polo style volunteer shirts are unisex and in men's sizes)J 
Pick Size 





The cost of the uniform is $15 dollars. If this creates a financial hardship and you need a loaner, please check here 


I understand St. Francis Health Center and the Volunteer Department assume no responsibility for youth volunteers who fail to report for scheduled assignments or for those who leave the building without permission. Each volunteer is required, by health c 
Type in Your Name/Signature 
Date 
Type in Your Parent/Guardian Name for Approval 
Date