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

If you have any questions along the way, please email us at

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

Contact & Demographic Information

Scheduling Preferences


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

Heart to Heart Volunteer Handbook:

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.