Please complete this application form if you are interested in becoming a OneWorld Community Health Centers, Inc. volunteer.  Please be aware that our current minimum time commitment for new volunteers is 4 hours per month for 4 months and all volunteers must already live in the Omaha, Nebraska area for at least 9 months per year.


Once you complete the form, click the Continue button at the bottom.


Volunteer Service Application and Agreement


Welcome

Welcome to OneWorld Community Health Centers! Thank you for your interest in volunteering with us!



Contact information


Availability

Place a checkmark in the boxes that correlate to when you are available.



Assignments

Check all assignments you have interest in. You may click on the assignment title to see more information regarding the assignment.

(Not all assignments have openings available)



Emergency Contact

In the event of an emergency whom should we notify?



Skills and Characteristics

Check all that apply



Organizational Contact

Is their an Organizational Contact that will need verification of your volunteer hours? If yes, please complete this section.



OneWorld Volunteer Manager

Volunteer Application Form must be submitted prior to volunteer service to the OneWorld Volunteer Manager: 

Courtney Spurgeon cspurgeon@oneworldomaha.org o: 402-502-8917 c: 715-309-9430



Electronic Signature

By clicking "I Agree" below you are acknowledging and agreeing to the following:


• I agree to volunteer at OneWorld and to perform only the mutually agreed upon services.

• I am fully aware that my activities as a OneWorld volunteer may involve certain risks. Knowing this, I assume responsibility for all my actions while performing my volunteer activities and I agree to hold OneWorld Community Health Centers and their employees, and other associated parties harmless from all claims arising out of, or in any way connected to, my volunteer duties. Further, I assume liability for any non-participants who accompany me.

• I agree to comply with HIPPA guidelines to protect and keep private all patient data I become aware of, including but not limited to: name, date of birth, contact information, diagnosis, and any other identifying factors.

• I agree to refrain from photographing, filming, or recording patients of OneWorld.

• If I drive a vehicle during the course of my volunteer work, my personal vehicle insurance provides coverage.

• I will not perform my volunteer service under the influence of alcohol or illegal drugs.

• I agree to adhere to OneWorld’s Anti-Discrimination Policy: I will not discriminate on the basis of race, color, creed, religion, gender, age, national origin, marital status, sexual orientation, gender identity, disability, genetic information, familial or parental status, veteran status, any other non-job-related or legally-protected classification in any volunteer activities.


I understand that currently all OneWorld volunteer applicants must submit proof of Covid-19 vaccination prior to service. 


I understand and agree that submitting this application form does not automatically register me as a OneWorld volunteer, and that there may be certain qualifications I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.


By submitting this form, I attest that the information I have provided on the form is true and accurate.