NWB-Peacework Volunteer Application
Full Name *
Your answer
Gender *
Your answer
Age *
Your answer
Address *
Street, City, State/Province, Postal/Zip Code, Country
Your answer
Phone Number *
Include country code if outside of the US
Your answer
Email Address *
Gmail preferred
Your answer
Emergency Contact Info
Emergency Contact's Full Name *
Your answer
Relationship to You *
Your answer
Emergency Contact's Address *
Street, City, State/Province, Postal/Zip Code, Country
Your answer
Emergency Contact's Phone Number *
Include country code if outside of the US
Your answer
Emergency Contact's Email Address *
Your answer
Volunteering at Peacework
Have you volunteered with NWB before? *
If yes, where and when?
Your answer
Why do you want to volunteer with NWB at Peacework? *
Your answer
Please describe any work or volunteer experience you have working with underserved populations and/or in developing countries. *
Please include where you worked, when, with whom (organization/population, etc.) and what you did.
Your answer
Please list your formal education, beginning with your undergraduate university. *
Be sure to include the name and location of the university, dates you attended, your course of study, the degree you earned and any relevant honors and extracurricular activities you engaged in there. You may also include any certificates you have earned.
Your answer
If you have any clinical experience, please describe it below including the name and location of the hospital or clinic, the type of experience and the specialty you practiced.
Your answer
Please describe any skills you have that will be an asset to your volunteering experience. *
Your answer
What do you expect to contribute to this experience? *
Your answer
What do you expect to gain during this experience? *
Your answer
How did you find out about NWB's work at Peacework? *
Your answer
I hereby give my permission for photo or video to be taken of me while volunteering at NWB-Peacework from this date forward. I understand that photos or videos taken may be used by NWB for marketing and any other purposes they see fit. I further understand that this release form covers all NWB-sponsored activities from this day forth that I choose to participate in. *
If for any reason I wish to no longer allow my picture or video to be taken and used by NWB, it is my responsibility to notify NWB in writing that consent has been retracted.
Participant Level *
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This form was created inside of Naturopaths Without Borders.