Language
  • English (US)
  • St. Clare Health Mission

    Volunteer Application 

  • Thank you for your interest in volunteering with St. Clare Health Mission (SCHM). 

    St. Clare Health Mission has been serving the underserved and uninsured for over 25 years. We recently surpassed 19,000 patients and over 85,000 clinic visits.

    Those participating in this initiative share a belief that all individuals,regardless of financial status, are deserving of basic health care, and that all share in the benefit of that care.

    Our mission is threefold: provide healthcare to the uninsured, provide medical professionals the opportunity to serve others and strengthen our community, and provide students an opportunity to serve in a complex learning environment. 

    Our clinic hours are as follows: 

    Walk-in Clinic:  Tuesdays and Thursdays: 5:00pm - 7:00pm*

    *All volunteers and staff stay until the last patient has been served typically between 7:30pm and 8:30pm. 

    Continuity of Care Clinic: Wednesdays: 8:00am - 1:00pm

    Typically, volunteers are scheduled once every 6 to 8 weeks depending upon your availability and interest. We are quite flexible and willing to work with your schedule. 

    Thank you again for your interest in St. Clare Health Mission, you are truly the heart of our organization and your community. 

    • Personal Information  
    •  -  -
      Pick a Date
    •  -
    •  -
    • Desired Volunteer Position  
    • Personal Health Information

    • Tuberculin Skin Test

    •  -  -
      Pick a Date
    • Rubella Titer

    •  -  -
      Pick a Date
    • Hepatitius B Vaccine (optional) 

    •  -  -
      Pick a Date
    • Confidentiality and Background Disclosures

      Needed for Clinicians and Nurses only
    • Registration/Renewal Applicaiton for Volunteer Health Care Providers  

      Please click the link, print and complete the registration form, and upload to this volunteer application below. *It does not need to be notarized. 

      http://www.wifc3.org/Data/Sites/25/media/files/physician_volunteer_malpractice--6044_6-2011.pdf

       

    • Browse Files
      Cancel of
    • Background Information Disclosure (BID)

      Please click the link, print and complete the registration form, and upload to this volunteer application below. 

      https://www.dhs.wisconsin.gov/forms/f8/f82064.pdf

       

       

    • Browse Files
      Cancel of
    • St. Clare Health Mission follows strict guidelines as they pertain to HIPPA regulations.

      As a volunteer of St. Clare Health Mission I am responsible for maintaining patient privacy and confidentiality. When acessing patient information, I will use the minimum amount of information necessary to perform my duties. I will uphold all HIPPA guidelines and St. Clare Health Mission regulations. 

       

    • Thank you again for your interest in volunteering with St. Clare Health Mission. We look forward to having you join our team of volunteers.

      We will reach out to you shortly to shcedule a volunteer orientation at a time that works best for your schedule. 

    •    
    • Should be Empty: