Thank you for your interest in providing volunteer support with Heart to Heart International during the COVID-19 outbreak. Please complete the following application. Upon completion of this application, additional instructions will be provided regarding required paperwork. Please submit all paperwork as soon as possible.


If you have any questions along the way, please email us at volunteerdocuments@hearttoheart.org.


Please note, all selected volunteers are subject to criminal background and credential checks.


Contact & Demographic Information


Scheduling Preferences


Credentials

Please select the appropriate medical certifications and specialties you hold. Please ensure you select ALL states where you are currently licensed.



Emergency Contact


Volunteer Agreement

Please review the Volunteer Handbook:https://www.hearttoheart.org/wp-content/uploads/2021/02/Volunteer-Handbook-and-Code-of-Conduct-02-03-2021.pdf


By selecting "I agree" you have read and agree to uphold the policies outlined in the Heart to Heart Volunteer Handbook, and permit Heart to Heart International to share your information with Johnson County Department of Health and Environment and the MidAmerica Regional Council affiliated organizations.