IIC Volunteer Application

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We are looking for in-person clinical volunteers to support our mission at IIC. Volunteers are essential in assisting with mobile clinics and office operations, enabling us to deliver vital services to the community. If you’re passionate about community health and eager to make a meaningful difference, we’d love for you to join our team.

Full Name *

Preferred Name

Gender *

Male

Female

Prefer not to say

Other:

DOB (mm/dd/yyyy) *

YYYY

Phone number *

Email *

What region are you interested in? *

Central (Indianapolis)

North (South Bend, Fort Wayne, etc)

South (Bloomington, Evansville, etc)

List the beginning and end dates. *

What days of the week are you available to volunteer? *

What times are you available? (Morning / Afternoon / Evening) *

Are you comfortable working with the public?

Yes

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How many hours a week are you interested in working? *

20+

How do you feel about driving long distances?
*

I do not mind driving long distances around Indiana

I do not feel comfortable driving long distances

Required

Do you have reliable transportation to the volunteer site? *

Yes

Will you be willing to work evening clinics? *

Yes

Will you be able to work Saturday clinics? *

Yes

Why do you want to volunteer at the Indiana Immunization Coalition? *

Anything you want us to know about you?

Submit

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