Susu Health Foundation™ Volunteer Information

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Susu Health Foundation's mission is to advance healthcare in Liberia by empowering and supporting local healthcare talent and communities through sustainable collaboration, shared learning, and leveraging diaspora expertise and resources.

If you wish to volunteer with us to provide continuing medical education lectures and training remotely and/or in-person, or in a non-clinical capacity, please use this form to provide information regarding your background and interests.

Please email volunteer@susuhealthfoundation.org or call +1 (206) 451-7009 with questions.

1. Name *

3. Email address. This will be used to contact you regarding volunteer opportunities and will NOT be shared with any third party individuals or organizations without your explicit permission. *

4. Country of origin *

5. Country of residence *

2. Credentials (eg, MD, DO, RN, CRNA, PA-C, MOT, etc) *

City/State and Country in which you hold any clinical licenses. Please respond "non clinical" if you do not have any active clinical licenses. *

National Provider Identifier (NPI) Number if you are a US-based clinician. Please respond "N/A" if you are not a clinician, or if you are a clinician who is not based in the US. *

6. Primary medical specialty. Please respond "non-clinical" if you are interested in being a non-clinical volunteer. *

7. Subspecialty (if applicable)

8. Do you have any experience working in Liberia or another developing country? *

Yes

9. If you answered yes to question number 8, please provide a brief description of your prior experience.

10. Are you interested in remote or in-person volunteer opportunities? *

Remote only

In-person only

Both remote and in-person

11. Are you interested in giving lectures/presentations (remote or in-person), performing specialty chart reviews or participating in medical missions to Liberia? *

Lectures/presentations only (remote or in-person)

Medical missions only (to provide free medical care in Liberia)

Specialty chart reviews

All of the above

Other:

Required

12. Please list 3 topics related to your specialty that you would be able to present remotely or in-person. *

13. Please indicate your expected time commitment. *

Once a year

Twice a year

Three times a year

Four times a year

I don't know.

14. To what extent are you able to self-fund travel to Liberia? *

I can afford flight only, but will need assistance with lodging/food.

I can afford lodging/food only, but will need assistance with my flight.

I can afford neither flight nor lodging/food.

I don't know.

15. Additional comments or questions. Please use this section to indicate any areas of volunteer interests and relevant experience not covered elsewhere in this form.

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