Please complete this application form if you are interested in becoming a SET Family Medical Clinics volunteer.Once you complete the form, click the submit button at the bottom. A background investigation authorization form will need to be completed prior to proceeding to the next step.


Once the application is completed, please contact Jason Jones jasonjones@centura.org 719-776-8861, to continue the onboarding process.


Personal Information


Employment and Education


Professional License and Certification


Emergency Contact


Area's of Interest


Informed Consent, Release & Confidentiality Stmt

I, offer to volunteer my services to SET Family Medical Clinics. I do realize that I will not be paid in any way. I understand that this agreement can be cancelled at any time by SET or by me.


I release SET Family Medical Clinics, its employees, their heirs, agents, instructors and volunteers from any liability for loss or injury to my person or property that may occur due to negligence or other acts of omissions. This release applies to any losses or injuries that may occur as a result of, or during my participation in volunteer services.


I understand that any confidential information I might overhear must remain confidential, I understand that while acting as a volunteer of SET, I must observe the rules and regulations that apply to my volunteer position and that these rules are outlined in the job description.