SWAN Clinic Escort Volunteer Form 2023
NOTE: GOVERNMENT NAME AND ID IS REQUIRED UPON ACCEPTANCE. Application for clinic escort. Your information is safe among a select group of SWANs within our vetting team. They may reach out to you to gather additional information for the safety of our volunteers, patients, and clinic.

Your information is kept safe and not used for commercial purposes. If you have submitted an application and have not heard from us, check your junk mail or email us at inquiries@swanoforlando.org.
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Are you 18 or older? *
Full Government Name *
Are you OK with giving the clinic a copy of your government ID? This is for HIPAA and safety records. Please understand all risks.  *
Are you ok wearing a mask at the clinic? This is for personal identity protection.  *
What are your pronouns?
Clear selection
Do you live in driving distance of Orlando, FL?
 *
Do you have reliable transportation?  *
Email *
Phone number
Do we have permission to text you? *
Social Media (Please share one or more of your social media handles. If your profiles are private, please note it, and one of our members will reach out to you to conduct our vetting process.)
 *
Is there anything from your work or social media that is concerning or needs further explanation? 
Are you involved in any other organizations in Orlando/surrounding areas? *
If you answered YES to being involved in other organizations, please list them!
Why do you want to be a clinic escort? *
What days are you available? Note: The clinic is closed Sundays and Mondays. Select all that apply.
 *
Required
What time of day are you normally available? We need help from around 8:30am-3:30pm on weekdays and 7:30am-2:30pm on Saturdays. 
Clear selection
Have you ever been convicted of a felony?
 *
In case of being selected or pre-qualified, you might be asked for more details about criminal records.

Are you comfortable with this?

 *
Is there anything else you want to tell us about yourself?
How did you hear about us?
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