Connecticut Childrens Large

STOP:  Complete this application only if you have been accepted as a research volunteer. You will be required to enter your PI's name, department, phone number and email. 

Note: COVID-19 Vaccines, Boosters and Flu shots (during flu season) are mandatory for participation in our volunteer program

New User Details
*Highlighted fields are required

Address Information

Emergency Contact

Research Placement Information

Immunization Information
An Immunization Documentation Form

Link Here
signed by your healthcare provider must be
included with your application submission.

If accepted into the program, you will have a
maximum of two weeks to provide documentation
of either a 2-Step PPD OR negative QuantiFERON test.


By submitting my application, I understand that Connecticut Children's
will consider me for a volunteer position on the basis of the
information I have furnished on this application form, and that
any false, misleading or incomplete statements made by me,
or any omission of material fact shall prevent my volunteering or
shall be cause for immediate dismissal from my volunteer assignment.

I understand that the staff of the Volunteer Services Department
will be calling the references I have listed on this application,
and conducting a background check on me prior to being placed.
As part of the volunteer application process, and at any time
during my volunteer placement, I authorize Connecticut Children's
or any of its affiliates to obtain the record of any conviction for
commission of a felony.

[ clear ]