ICN SHIFA CLINIC

ICN SHIFA CLINIC Volunteer Application
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Birth Date*

MonthDayYear
Address

Street Address

CityState

Zip Code
I would like to volunteer as*
Please choose one category
If you are applying for a specialty care, Please mention your subspecialty
On average, how many hours on a monthly basis you intend to volunteer at ICN SHIFA Clinic*
Have your worked with an electronic medical record (EMR) system in the past?*

YesNo
Describe your previous medical experience (if any)
Describe your strengths that may benefit ICN SHIFA Clinic
You are trying to apply as a Triage Volunteer. We regret to inform you that at this time we are not accepting applications under this category due to high demand and a long wait time. Rest assured that your application will be saved in our records once you SUBMIT and once needed we will contact you first before accepting newer applications.

We apologize for any inconvinience, appreciate your understanding and wish you best of luck!

ICN SHIFA CLINIC ADMINISTRATION
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ICN SHIFA CLINIC Volunteer Application