Interpreter Application

Please complete this application form if you are interested in becoming a UAMS 12th Street Health & Wellness Center Interpreter. We especially need interpreters fluent in Spanish. Once you complete the form, click the continue button at the bottom.

Name & Contact Information

Please provide us with your name and current contact information.

First name:

Last name:

Title:

Street 1:

City:

State:

Zip:

Cell phone:

Work phone:

Fax phone:

Email address:

Educational Background

Please briefly explain your educational background and/or your qualifications as an interpreter.

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Date of birth:

Gender:

Volunteer Assignment

Please choose Interpreter from the following list.

Employer Information if applicable

Please provide us some information about your employer. If you are a student, please provide that information as well.

Employer name:

Office Address:

City:

State:

Zip:

Work phone:

Emergency Contact Information

In case of emergency, please provide us with someone that we can contact.

First name:

Last name:

Home phone:

Cell phone:

Relationship:

Password Creation

Please select a password of your choice. This will be the password you use to access the online volunteer schedule from off our website.

Please enter a password that:

Is between 6 and 30 characters long
Contains both letters and numbers.

Password:

Confirm password:

Authorization and Release

I release from liability all representatives of 12th Street Center for acts performed to verify my eligibility and credentials to volunteer and all individuals and/or organizations who provide information concerning my qualifications.

By clicking "I agree", you verify that all the above information is correct and agree to uphold the rules and regulations of the UAMS 12th St. Health & Wellness Center and agree to complete all of the necessary components to become a volunteer.

I Agree

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