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Please fill out the following questionnaire. You will be contacted by our staff to complete the rest of the application process.

If you have any questions regarding Student Volunteering please call (661) 377-1700 and ask for our Student Volunteer Coordinator.

Student Volunteer and Emergency Contact Information

Volunteer Name *

Phone Number *

Email *

Emergency Name *

Phone Number *

Relationship *

1. Why are you requesting volunteer hours?

2. Preferred Start Date?

3. How many hours do you need to complete in this setting?

4. Do you plan to pursue a career in therapy?

5. What school do you currently attend?

6. What is your major?

7. When do you expect to graduate with your...

Bachelor's?

Master's?

Doctorate?

8. To which Physical/Occupational/Speech Therapy schools do you plan to apply?

9. Have you volunteered or shadowed with any other Physical/Occupational/Speech therapists?

10. Have you worked for any other therapy companies?

11. What are your goals for volunteering at TERRIO?

STUDENT VOLUNTEER APPLICATION