AFMC Volunteer Application

AFMC Volunteer Application
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is your highest education level?*

High SchoolAssociateBachelor'sMaster'sPhD/MD
Are you a licensed healthcare provider?*

YesNo

Skills, Interests, and Availability
Describe your skills*
Languages you have working proficiency in. Our most critical need is for volunteers that speak English and Spanish.*

EnglishSpanishChineseVietnameseOther
Tell us about your interest in volunteering with AFMC. Please be explicit if your interest includes the desire to get a letter of recommendation for pursuing a career in healthcare.*
What is your availability?*

Weekly (Preferred)Two times per monthOnce a monthOther
What is the total number of hours per month you are able to commit?*
For our front line volunteers that are not licensed healthcare providers, we look for 8 AM to 12 PM commitment every Saturday plus 1 or 2 hours during the week. We are more flexible for licensed healthcare providers and back office volunteers.
How many months are you willing to commit?*
For our front line volunteers that are not licensed healthcare providers, minimum we look for is 12 months of commitment. We are more flexible for licensed healthcare providers, Spanish interpreters, and back office volunteers.
Are there any mental or physical health impairments that would affect your ability to perform any of your duties, with or without reasonable accommodation, according to accepted standards of professional performance? If yes, please describe.*
Please upload your resume or CV*

Cancelof
Your Signature Signature*
Date Date*
For AFMC only
AFMC Decision
AFMC Decision comment
Should be Empty:

For AFMC only