Kind Clinic Volunteer Application
Thank you for your interest in volunteering with the the Kind Clinic! As a volunteer, you'll have the unique opportunity to work alongside our professional staff and partners. We offer a range of service opportunities and your help is fundamental and essential to improve the health and wellness of our community.

To get started, please complete the volunteer application and a Kind Clinic staff member will contact you if there is a match for an open position.

Email address
Date of Application
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First Name
Your answer
Last Name
Your answer
Preferred Name (if different than above)
Your answer
What is your date of birth?
MM
/
DD
/
YYYY
Do you consider yourself a member of the Lesbian, Gay, Bi-sexual and/or Transgender Community?
What is your gender?
Do you identify as transgender?
What pronouns do you use? (check all that apply)
Required
Current Address, City, State, and Zip Code
Your answer
Primary Phone
Your answer
Work Phone
Your answer
Emergency Contact
(Name, Relationship, Primary Phone Number)
Your answer
What is your highest level of education?
Employment Information
(Employer, Address, Phone Number)
Your answer
What are your volunteer interests?
Check all that apply.
Required
Special Skills or Certifications
Check all that apply.
Required
What languages other than English are your fluent in?
Your answer
T-Shirt/Sweatshirt Size
Will you be able to volunteer with the Kind Clinic in the area of interest indicated for the time period of at least six months?
Will you be able to attend Kind Clinic's periodic volunteer informational meetings, trainings, and open discussions?
Tell us why you might not be able to attend:
Your answer
How did you hear about volunteer opportunities at the Kind Clinic?
Referral Name:
Your answer
Most people want to volunteer to give back to their community. What are your reasons for wanting to volunteer at the Kind Clinic?
Your answer
The Kind Clinic welcomes patients from many different perspectives, backgrounds, and world views. Describe what you will do to help an individual coming in for services feel welcome, accepting, and safe.
Your answer
For you personally, what is the most important aspect of volunteering?
Your answer
By typing your full name below and clicking submit, you certify that all responses to this document are true to the best of your knowledge. You also agree that all information may be verified by Texas Health Action.
Please type your full name
Your answer
Please complete the captcha before submitting the form.
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