1000 Smiles Application 2023

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

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: *

JA Week SS: Spring Sealant JAMAICA - Apr 22 to May 1

SLU Week 1: 1000 Smiles ST LUCIA - Jul 21 to July 30

SLU Week 2: 1000 Smiles ST LUCIA - July 29 to Aug 7

Follow-Up Care: ST LUCIA - Aug 5 to Aug 13

GD Week 1: 1000 Smiles GRENADA - Aug 18 to Aug 27 (SOLD OUT - UoT)

GD Week 2: 1000 Smiles GRENADA - Aug 25 to Sept 3

GD Week 3: Fall Sealant Project GRENADA - Aug 25 to Sept 3

TCI Week 1: 1000 Smiles TURKS & CAICOS - Oct 13 to Oct 22

TCI Week 2: 1000 Smiles TURKS & CAICOS - Oct 21 to Oct 30

Follow-up Care: TURKS & CAICOS - Oct 28 to Nov 5

JA Week 1: 1000 Smiles JAMAICA - Aug 11 to Aug 20

JA Week 2: 1000 Smiles JAMAICA - Aug 19 to Aug 28

JA Week 3: 1000 Smiles JAMAICA - Aug 26 to Sept 4

JA Week 4: 1000 Smiles JAMAICA - Sept 8 to Sept 17 (SOLD OUT - UCLA)

JA Week 5: 1000 Smiles JAMAICA - Sept 16 to Sept 25

JA Week 6: 1000 Smiles JAMAICA - Sept 29 to Oct 8 (SOLD OUT - UoP)

JA Week 7: 1000 Smiles JAMAICA - Oct 13 to Oct 22

JA Week 8: 1000 Smiles JAMAICA - Oct 21 to Oct 30

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.

YYYY

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. *

I HAVE volunteered in previous years with 1000 Smiles

This will be my FIRST time volunteering with 1000 Smiles and on any Great Shape! Inc. project

I have NOT volunteered on 1000 Smiles before, but I have volunteered with another Great Shape! Inc. project: iCARE, SuperKids, Teach the Teachers

Clear form

Never submit passwords through Google Forms.

This form was created inside of Great Shape! Inc.. Report Abuse

Forms