UGM Free Medical Clinic Volunteer Application Form

Student Affairs

200 University Parkway, Suite 317

Yakima WA 98901

Phone: 509-249-7724

Fax: 509-249-7909

UGM Free Medical Clinic Volunteer Application Form

Name*

First NameLast Name

Date*

MonthDayYear

Class Level*

PNWU students have the unique opportunity to interact with real patients at the Union Gospel Mission Free Medical Clinic.

If approved, students can work alongside a community licensed health professional while enhancing their skills.

Signature*

First NameLast Name

Phone Number*

Area CodePhone Number

You will receive an official notification email from Student Affairs if your application is approved. You will not be able to start your UGM volunteering until you receive your approval email. Please email studentaffairs@pnwu.edu with any questions regarding the status of your application. Thank You.

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