Volunteer Application Form: HealthCare Students

Health & Help

Medical Student Volunteer Application Form
Health & Help consists of proactive people who want to solve global problems. Whether online or in our clinics in Guatemala and Nicaragua, every day we work to make the world a better place.

Here at Health & Help we believe anyone can help those in need and make the world a better place, even if you lack experience or don’t have a medical degree yet. We are happy to have medical students join our program and work under the guidance of experienced doctors. Medical students at Health & Help are not afraid to take on responsibility and can find the inner strength to help the sick and frail on a 24/7 basis.
Name*

First NameLast Name
Birth Date

MonthDayYear
Email*
example@example.com
Phone Number*

Country CodeArea CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Level of Education
What discipline are you studying?*
How long is your program?*
What is your current year of study?*
In which clinic would you like to volunteer?
Which of the volunteering activities interest you?
Do you have any volunteering experience? If yes, please describe.
When Will You Come?

Start Date must be a Sunday. End Date may be a Friday or Saturday. If your dates are firm, please email us first to check if we have space before applying; HR@he-he.org
Desired Start Date *

MonthDayYear
Date
Desired End Date

MonthDayYear
Date
Additional notes about your schedule
How did you hear about us?
Emergency Contact*

NameRelationship
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Spanish Fluency
Please provide your estimated level of fluency in Spanish. Please note that it is not required that you are fluent in Spanish. This information helps us ensure we have enough Spanish-speakers at any given time.*
Files to Upload:

NOTE: If your documents are not scanned clearly, are blurred, or numbers/names can not be read clearly, your application will not be approved so please DOUBLE CHECK the clarity before you upload them! Only PDF files are accepted. Any applications submitted without PDF files will NOT be considered. Files MUST be named correctly in order for us to process your paperwork. Each uploaded document must include: Lastname_Firstname_DocumentFor example, the file name of your resume would read: Lastname_Firstname_Resume
Passport Photo Page (IN COLOR)*

Cancelof
Resumé*

Cancelof
School Identification (IN COLOR)*

Cancelof
Letter of Recommendation #1*

Cancelof
The document is available in both English and Spanish, please read and sign the document in the language of your preference.*
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Health & Help

Level of Education

When Will You Come?

Spanish Fluency

Files to Upload: