ULM School of Nursing - Volunteer Request Form

Faculty and Students in the School of Nursing view volunteerism as a part of the professional role of the Registered Nurse. Service to the community at large offers us an opportunity to provide health teaching, assessments and referrals for further evaluation. Opportunities to serve are considered on an individual basis keeping in mind the mission of the university and the school. Advanced notice of volunteer requests are preferable to ensure planning of events and services. Please complete the form below and submit it for review. You will be contacted regarding our ability to meet your request. After completing and submitting this form, if you have additional questions, please contact the School of Nursing at 318-342-1640.
Contact Information
* Title:
* First Name:
* Last Name:
* Phone:

Agency Information
* Agency Name:
* Agency Address:
* Agency Phone:

Event Information
* Event Name:
* Event Start Date/Time (ex. 9/5/2009, 10:00AM):
* Event End Date/Time (ex. 09/06/2009, 4:00PM):
* Event Location:
* Directions to Event:
* Please describe volunteer activity. Include number of volunteers needed, resources required and duties to be performed.
* Please describe how this event benefits patrons of your agency and the community.
* Please indicate the person at your agency who will be best suited to complete a post-event Volunteer Evaluation. Please include a mailing address and email address.
Required fields denoted with *