CCCHC Volunteer Application
Thank you so much for your willingness to serve! Please contact the volunteer/office coordinator Ornella Ngamboma at
if you have any questions.
If you have multiple, please list each one separated by a comma. Also, please indicate the type of phone in parentheses. Example: 217-402-5683 (cell), 217-398-2914 (work).
Do you accept text messages on your phone?
Email is the primary mode of contact for CCCHC. This would be only for scheduling purposes or other urgent clinic business. For example: if we need someone to fill in for a late volunteer cancellation.
You must provide at least two references including relationship to you, phone number, and email for each. Please list the first below.
You must provide at least two references including relationship to you, phone number, and email for each. Please list the second below.
What area are you interested in volunteering with?
See descriptions of each area in the Volunteer Handbook under "Volunteer Job Descriptions" at:
. You may choose more than one area. If there are MEDICAL QUALIFICATIONS listed by the area, you MUST have one of those to volunteer in that area! If you have no medical qualifications you can ONLY do the areas listed as non-medical.
Hospitality (non medical)
Spiritual Care (non medical)
Food (non medical)
Interpreter (non medical, mainly Spanish needed)
Triage (EMT, CNA, Med Student, Nursing Student, Residents)
Social Work (LCSW, LSW)
Provider (MD, DO, APN, PA, must have already COMPLETED residency)
Discharge (RN, Residents)
Lab (Experience in phlebotomy needed)
Are you fluent in any OTHER LANGUAGES to the point that you would be able to interpret medical information?
The following languages are the most common. However, feel free to list any languages other than English you are FLUENT in.
Chinese - Mandarin
Chinese - Cantonese
Are you interested in helping out with fundraising opportunities?
Are you experienced with grant writing or would you be interested in grant writing?
Yes, I have experience and I would be interested in helping with grant writing
No, I do not have experience but would be interested in helping with grant writing
No, not interested
Are you a student?
If yes to the last question, what month and year do you expect to graduate?
Current Place of Employment
If you are primarily a college student please leave this AND the next question blank and proceed to the next section.
Any other comments or questions? Please share your input here.
By checking this box, I verify that I have read, understood, and agree to the universal precautions policy and volunteer agreement. You can view these and the volunteer handbook at:
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