Volunteer Sign Up Form

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Thank you for signing up to be a volunteer with the WD Palmer Foundation. Please fill out your information and interests below, and follow the instructions at https://thewdpalmerfoundation.org/petition-information-page/ for next steps.

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Email *

Phone Number *

Map of Regional Breakdown

Choose the state/territory that you will be performing outreach in: *

Select the group(s) that you will work on outreach to (you do not have to be affiliated with the group) *

American Medical Association

Arts organizations/groups

Business organizations/corporations

CDC

Churches: minister, etc

City councils

Colleges: Students, administrations, staff, alumni

Community health centers/ mental health centers: directors, staff, patients

Community organizations/associations

Dental schools: Students, staff, alumni

EMT schools

Fraternities

High schools

Hospices: Administrations, staff, and patients

Hospitals: Administrations, staff, and patients

Laboratories (radiology, blood)

Libraries

Medical practitioners, dental, veterinary

Medical researchers

NABS

NAM

NIM

NINH

News Stations and Organizations (Print, TV, Radio)

Nursing homes

Nursing schools: Students, staff, alumni

School of Psychiatry: Students, staff, alumni

School of Psychology: Students, staff, alumni

Schools of pharmacy: Students, staff, alumni

Schools of social work: directors, admins, students, staff, and alumni

Senior citizen complexes

Social agencies, youth, seniors, adult centers: Administrations, CEOs, staff, and clients

Social clubs

Sororities

State legislators

State senators

The National Association of Social Workers

The National Black Alliance of Social Workers

Veterinary schools: Students, staff, alumni

Other:

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