Please complete this application form if you are interested in becoming a Health and Hope Medical Outreach volunteer. Also don't forget to download the forms that need signed at the end of the application. Once you complete the form, click the submit button at the bottom.
This information is optional. It is used only to provide volunteer demographics in grant applications.
The clinic is open only on Tuesdays from 5:00 pm to 8:00 pm .
We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email. We will send you only the emails you prefer to receive. Use the check boxes below to select the your email preferences.
Have you been convicted of any criminal offense including, but not limited to, drugs, theft, or inflicting bodily harm, sexual or emotional injury? If yes, please explain.
Professional Skills: MD/DO ( ) PA ( ) ARNP ( ) RN ( ) LPN ( ) CNA ( ) MA ( ) LAB TECH ( ) PHARMACY TECH ( )
School and year graduated:
Attach a copy of your license or certification, CV or Resume and COVID Vaccination Card.
Open the Volunteer Forms link and print off these forms, sign them, and bring them with you to orientation.
Volunteer Forms <---Click Here
HIPPA & Release Completion Date:__________________________
Background check___________________ WATCH Letter ________
Volgistics _______________ Phoenix _____________________
Medical sent to Credentialing Date:___________________
Resource: Sent to Spiritual Care Date:________________