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Pocatello Free Clinic Volunteer Application
We are grateful for your interest in volunteering at the Pocatello Free Clinic! Please complete this short form.  If you have questions, please email our volunteer coordinator at egalo@pocatellofreeclinic.org 
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Email *
Name (Last, First, M.I.) *
Contact Phone Number *
Are you over 18 years of age? (May impact how you can help at the Free Clinic) *
Occupation (if applicable)
Are you fluent in any other language(s) besides English?
Other language(s) spoken:
In what capacity are you interested in volunteering with the clinic?  (check all that apply) *
Required
For which clinic location(s) are you interested in volunteering? (check all that apply)
What, if any, previous volunteering experience do you have?

Does this service fulfill volunteer requirements for job, school, community service, licensure, etc.? If so, explain.

 *

What is your motivation for volunteering at the Pocatello Free Clinic?

 *

What do you expect to be your minimum commitment to volunteering? (one semester, other, etc.)

 *
Select the days and hours you are available to volunteer. *
9 AM - NOON
2 PM - 6 PM
Not Available
Monday
Tuesday
Wednesday
Thursday
Friday
A copy of your responses will be emailed to the address you provided.
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