Medical Mission Ecuador Volunteer Application  2027
We will be accepting applications for 2027 from Summer 2026 through October 1, 2026. Unfortunately, not all who apply will be able to attend. We will assess our needs and match up the volunteers that fit those needs to best serve our patients. We have a limited amount of space and preference is given to medical volunteers.  For 2026, we had a full complement of volunteers.  If we have all of those members return again we will not have any significant spots available for new volunteers this year unfortunately.  We will fill the space that is available with the most qualified individuals.

ALL VOLUNTEERS NEED TO FILL OUT AN NEW APPLICATION. Must be over 18 years of age.

***If you have not previously volunteered or have no volunteer member for reference, you MUST fill out the section on the application with a brief identifying note about yourself (for example: OR Scrub tech with 10 years experience in Ortho) as well as email us to describe your interest, qualifications, and how you anticipate you can be of help to the mission at medicalmissionecuadorusa@gmail.com. Applications lacking this information will be discarded. Thank you.***

Please do not make concrete plans to attend the mission until specific approval has been given via email from administration. It may take until December 2026 to determine our needs, although you may have confirmation long before then. This still allows 2 months of planning time. If you do not hear back from us within 7 days of sending your initial email, please reach out to medicalmissionecuadorusa@gmail.com.  
Sign in to Google to save your progress. Learn more
Email *
Last Name *
First Name *
Most Advance Degree *
No periods please. (Ex: BA, MS, BSN, MD, or PhD, etc...)
Specialty *
Street Address: *
Street 2 (if needed):
City *
State: *
(2 letter abbreviation please)
Zip Code: *
(5 digit zip code)
Contact Textable Phone number Please - type out as shown below with hyphen: *
(VERY IMPORTANT! xxx-xxx-xxxx format please!)
Emergency Contact Name: *
Emergency Contact Address Phone: *
(VERY IMPORTANT! xxx-xxx-xxxx format please!)
Emergency Contact Relationship to you: *
I will download the WhatsApp application as this is the main communication method for volunteers. *
Passport Number: *
This information is needed for our hotel in Ecuador. If you do not have it with you, you will need to provide it eventually. When you look it up, please put it down in your phone so you will always have it available.
Passport Expiration Date: *
Please put in the date so we can be sure there are no expiration problems. The Eric Miller Rule. Your passport must be valid for 6 months from the start of your travel to Ecuador. This is a USA CBP rule, you will not be allowed to leave the US without this.
MM
/
DD
/
YYYY
Passport Country *
Are you currently licensed in the field that you are volunteering in which you plan to participate?  *
Please indicate below if you have read and accept the terms of the MME USA Waiver *
If you have not read it, it is located here
Please acknowledge that the mission works at an elevation of above 6,000 ft and may pose health issues, so please take that into consideration for your application *
If you have experience in the area of fundraising or social media awareness and be be interested in participating in a committee for the mission please indicate below
Clear selection
Prior Medical Missions Attended: (If you have not previously attended our mission trip, you must contact us with a letter of introduction. If we do not receive this, we will not be able to consider you for the trip. medicalmissionecuadorusa@gmail.com) *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms