Advanced Practice Provider (APP) (NP/PA/Midwife/PT/OT) Volunteer Application Form
Please be advised that this application may take up to 30 minutes to complete. Additionally, we require that you include 2 references as a part of our credentialing process.

Advanced Practice Providers (APPs): NPs, PAs, PTs, OTs, and Midwives
-Evaluate, diagnose, educate, and treat patients within their scope of practice
-Adhere to local, state and national regulations

Requirements: Completed PACH Advanced Practice Providers Volunteer application, attended PACH orientation, completed PACH “Best Practices” cultural humility training, current HIPAA training, current Bloodborne Pathogens training, have current health insurance, obtain secondary needlestick policy (available at low cost through PACH), completed personnel file per FTCA requirements.

Thank you for your interest in volunteering with PACH! Please fill out this application and we will be in contact with you.

Click "Next" to begin the application.

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