volunteer

Hearing Screening Volunteer Form

First Name: * Required
Last Name: * Required
Employer/School/Clinic:
Mailing Address: * Required
City: * Required
State: * Required
Zip: * Required
Contact Phone Number: * Required
Email: * Required
Do you speak conversational Spanish?   Yes   No
Are you available to stay 7:00am to 4:00pm?   Yes   No
Are you available to stay after the fair to help clean up?   Yes   No
PLEASE INDICATE YOUR WORK AREA PREFERENCE
TonesYes   No
TympsYes   No
OAEsYes   No
OpenYes   No
PLEASE INDICATE YOUR PREVIOUS HEARING SCREENING EXPERIENCE (outside of classes)
TonesYes   No
TympsYes   No
OAEsYes   No
OpenYes   No
PLEASE INDICATE ANY PREVIOUS ACT HEALTH FAIR VOLUNTEER WORK
TonesYes   No
TympsYes   No
OAEsYes   No
DO YOU HAVE ANY HEARING SCREENING EQUIPMENT AVAILABLE TO USE AT THE FAIR?
P/T Screener(s)No   Yes:   #
Otoscope(s)No   Yes:   #
Tymp Screener(s)No   Yes:   #
OAE Screener(s)No   Yes:   #
ARE YOU A
Certified Audiologist
ASU Grad Student
NON-ASU Grad Student
Undergrad Student
What is your T-Shirt size?
  NOTE: When volunteering a valid photo id will be required.