1000 Smiles Application 2023
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First Name (Your LEGAL FIRST NAME) *
Name you prefer to be called on nametag *
Last Name *
Email Address (if you are a dental or hygiene student please provide us with a non-school address HERE): *
Please note, if you are filling out an application for multiple people, YOU MUST provide a unique email address for each application you are completing. We CAN NOT send multiple DocuSign packets (volunteer paperwork) to the same (one) email address. Dental and hygiene students PLEASE list your school email as your alternate in the next question.
Please provide an alternate email address in case of technical difficulties: *
Occassionally, we have technical challenges with DocuSign (especially with university emails) so it's helpful to have a 2nd email on file if you have one. If you don't have an alternate email please write N/a below. Dental and hygiene students, please list your school email address here.
Please select the one week that would be your first choice to volunteer: *
Please list alternate weeks (include island name) that you are available and willing to go if your first choice is not available. *
Best Phone Number Type *
Work Phone Number *
Cell Phone Number *
Home Phone Number *
What are the best days to reach you (please note if there are days that your office is closed) *
The best mailing address to reach me is my: *
Work Address - Street *
(include apt or suite #)
City *
State/Province *
Zipcode/Postal Code *
Country *
Home Address - Street *
(include apt or suite #)
City *
State/Province *
Zipcode/Postal Code *
Country *
Gender Identification (For Room Assignments Only) *
Birthdate *
(MM/DD/YYYY) Be sure to type this date in. Please don't use the drop down arrow because it auto defaults to the current year.
Including this year, how many years have you volunteered on this project? *
Ex: If this is your first year volunteering you would select "2023 will be my first year volunteering" otherwise you'll select how many years you've volunteered
T-Shirt Size *
Select which statement applies to your volunteer experience with 1000 Smiles and/or Great Shape! Inc. *
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