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Centre Hospitalier de Fontaine Foundation VOLUNTEER PRE-REGISTRATION FORM
WE ARE NOT YET ACCEPTING VOLUNTEERS, BUT ARE DEVELOPING A PROGRAM TO DO SO BY THE END OF Q2 , 2024 IF THE SOCIOPOLITICAL CLIMATE IS FAVORABLE.
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Email
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Your email
First and Last Name
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Your answer
Phone Number
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Your answer
Mailing Address
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Your answer
Profession / Title ( If still in college, enter your Major)
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Your answer
Level of Education (Please do not be ashamed. Everyone can help)
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High School Diploma / GED
Undergraduate Degree ( In Progress)
Undergraduate Degree (Completed)
Graduate Degree ( Masters/Specialist - in Progress)
Graduate Degree ( Masters/Specialist - Completed)
Graduate Degree ( PhD - In Progress)
Graduate Degree (PhD - Completed)
Which Volunteer Opportunity (ies) resonates with you the most ?
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In-Person Medical ( Licensed Only) * Patient Care , Pharmacy , Laboratory
In-Person Non-Medical ( Consultant, Equipment repair , Construction, teach a course, vocational )
Virtual- Medical (PhD and MD only) ( Educator, Mentor, Telehealth, Consultant )
Virtual - Non-Medical (Teach, Coach, Consult, , Mentor, Develop , Compose)
In-Person : Child, Youth, and Young Adult Development and Well being ( camps, counseling, therapy, mentorship)
Virtual - Child, Youth, and Young Adult Development and Well being (camps, counseling, workshops. mentorship...)
Become a verified Ambassador - Fundraise, organize drives on our behalf. Connect us to Sponsors
Serve on our Giving Board (Monthly contribution required)
Ideally we would like to launch our volunteer program between April - June 2024 depending on the sociopolitical climate. Your safety is important to us.
When do you believe you will be ready to start volunteering your time ?
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April-June 2024
July - September 2024
October - December 2024
2025
** In-Person Volunteers Only: How long do you believe your stay could be?
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1-2 nights
3-4 nights
5-6 nights
**In-Person volunteers only : Are you willing to lodge at the CHF Dormitories ?
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Yes
No
Will you agree to a background , license check, providing a reference list, and an interview ?
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Yes
No
We are grateful that interest in volunteering with us despite the news about Port-au-Prince Haiti is high. However, when the time comes, a $150 - $500 registration fee will be required at the time of registration.
Why : To prevent us from spending our donors' hard earned donations, and our time on preparation for individuals with no real intention of following-through.
Would you like to receive the formal registration form via email when the time comes.
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Yes, send me the registration email when it's time.
No, do not send me the registration email.
We will read your answer to our staff to encourage them.
How did you hear about us ?
How have we inspired you?
Why are you willing to volunteer your time, when most people see a failed nation with no hope?
Why is this important to you?
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Your answer
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