Volunteer Application
Thank you for your interest in volunteering at Impact Mental Health. We highly value our volunteers and the services they provide.

There are many ways you can serve at Impact. Here are some of the most essential, but we are always open to other skills you may bring :

Spanish Interpreters
Care Coordinators (meet with individuals as they make their first contact with the clinic to build repoire, establish qualification for treatment and gather pertinent information regarding the presenting issue).
Fund Development
Social Media presence
Filing
Technological Assistance
Nursing skills (taking patient vitals, gathering medical history, assisting with medication assistance program).

Please complete this application and submit it to our Volunteer Coordinator. Upon review, she will reach out to you to schedule an interview. We ask our volunteers to serve at least 3-4 hours per week but depending on the role, that can vary. Training is done the first day in clinic and subsequently as desired and needed.

Again, thank you for your interest in volunteering with us! Impact is a non-traditional model of providing quality care to the uninsured and impoverished population in Utah who are challenged with mental illness.

Email address *
Name
Email
Address
Date of Birth
MM
/
DD
/
YYYY
Primary Phone Number
How did you hear about us?
What do you expect to gain from your volunteer experience?
List any previous volunteer experiences:
List any skills you have that may be used in the clinic:
How many hours per week/month would you like to volunteer?
What days/times are you available to volunteer?
Clear selection
Have you ever been convicted of a felony?
Clear selection
Emergency Contacts (Please provide name and number)
Education (include all that you have completed beginning with high school)
License/Certification
3 References (Include Name, Phone Number, and Email Address)
Submit
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