CCCHC Volunteer Application
Thank you so much for your willingness to serve! Please contact the volunteer/office coordinator Ornella Ngamboma at volunteer.ccchc@gmail.com if you have any questions.
Last Name
Your answer
Email Address
Your answer
Phone Number
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).
Your answer
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.
Home Address
Your answer
Reference #1
You must provide at least two references including relationship to you, phone number, and email for each. Please list the first below.
Your answer
Reference #2
You must provide at least two references including relationship to you, phone number, and email for each. Please list the second below.
Your answer
What area are you interested in volunteering with?
See descriptions of each area in the Volunteer Handbook under "Volunteer Job Descriptions" at: http://ccchc2003.org/Volunteer. 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.
Required
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.
Are you interested in helping out with fundraising opportunities?
Are you experienced with grant writing or would you be interested in grant writing?
Are you a student?
If yes to the last question, what month and year do you expect to graduate?
Your answer
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.
Your answer
Profession, Specialty
Your answer
Any other comments or questions? Please share your input here.
Your answer
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms