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Basic information

Your full name
Local address

Local address

Do you have a different permanent address?
Permanent address

Permanent address


Are you currently a student?


Are you currently employed?

Please provide us with a bit more information about yourself, why you want to volunteer, what your goals are, and what your preferred service areas are.
Do you have any education, training, work experience, etc that would be beneficial as a volunteer at Gundersen? 

I understand and agree that at no time will any information regarding patients of Gundersen Health System be revealed to anyone other than those authorized to receive it. I understand that the giving of information concerning a patient to those not authorized to receive such information is unlawful and shall be sufficient cause for my immediate dismissal.

I agree to any necessary health screening required by Gundersen Health System and understand my volunteer assignment is contingent upon successful completion of this screening. I understand that any false statements made as a part of this application may be considered sufficient cause for dismissal. 

Should the volunteer orientation process move forward - I authorize permission for all named references to release personal and professional information to the Volunteer Services office. I also consent to a background check. I further release Gundersen Health System, as well as those supplying said information, from any and all liability from these investigations.

  • I will abide by Gundersen Health System’s general policy concerning patient confidentiality.
  • My assignment is on a probationary basis for a period of 90 days.
  • I voluntarily offer my services with a clear understanding that there is no monetary compensation.
  • I will observe all Gundersen Health System’s regulations.
  • A minimum six month commitment or full school semester is required.

By typing your name, you are electronically signing this form.

1900 South Ave.
La Crosse, WI 54601

(608) 782-7300

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