Health Tech for Medicaid Volunteer Interest Form
Name
First Name
Last Name
Email
example@example.com
Pronouns
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Location
Ex. Oakland, California
Education
School and Degree
How many hours a week would you like to volunteer with HT4M?
3-6 hours/wk
6-9 hours/wk
9-12 hours/wk
12-15 hours/wk
15+ hours/wk
What days are you available to volunteer? (Select all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Any special skills you have that you feel would benefit our organization?
What start (and end) dates would you be available to volunteer?
What projects/initiatives would you like to be involved in?
Planning HT4M's Annual Future of Medicaid Innovation Forum (annually in January)
Underrepresented Founder Database
BLK in Health
Venture 4 Medicaid
Sexual, Reproductive, Maternal/Birthing Health Equity work
Policy and Advocacy
Social Media Presence and Engagement
Other
Feel free to upload a PDF resume/CV in this space below.
Browse Files
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Choose a file
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of
LinkedIn/Website
How did you hear about us?
Anything else you would like us to know?
Submit
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