Please com­plete this appli­ca­tion form if you are inter­est­ed in becom­ing an Iowa Donor Net­work vol­un­teer. A mem­ber of our team will fol­low up with you after the appli­ca­tion has been submitted.

Education / Employment

(if currently enrolled)

Your Connection to Donation

(Hospital or Medical Center)

Volunteer Background Information

Personal Background Information

(A conviction record will not necessarily bar team membership. Factors such as age of the offense, seriousness and nature of the violation and rehabilitation will be taken into account.)

Emergency Contact Info

Volunteer Agreement

I understand that the following are expectations of the Iowa Donor Network Volunteer Program:

  1. I certify that the information provided in this application is true and correct in all respects without any willful omissions.
  2. I understand that I may be screened at Iowa Donor Network’s cost for a background investigation. The investigation shall include, but is not limited to: Motor Vehicle Records Check, Social Security Trace, Child Abuse Registry Check, Criminal History Check, Education Verification and/or employment verifications. A positive finding for any of the above, such as a conviction or court-imposed penalty for a crime, may preclude me from consideration as a volunteer.
  3. I will demonstrate a courteous, knowledgeable and professional manner in all interactions in my role as an Iowa Donor Network volunteer.
  4. I will complete the necessary training required for my volunteer role and keep current with Iowa Donor Network communications and information for volunteers.
  5. I agree that as an Iowa Donor Network volunteer, I am responsible for maintaining the confidentiality of all proprietary or privileged information to which I am exposed.
  6. I am advised that failure to comply with these policies may result in disciplinary action which could include release as an Iowa Donor Network volunteer.

Our Vision:

All are inspired to donate life.