SAANTX Volunteer Form
Thank you for your interest in volunteering with SAANTX Medical Clinic! Volunteers must be at least 18 years old and are required to commit to working at least one Saturday each month. Clinic hours for volunteers are from 9:00 AM to 1:00 PM. Please note that submitting this form does not guarantee a volunteer position—you will be contacted if a spot becomes available. We appreciate your willingness to serve the community!
Name
Volunteer As:
Please Select
Medical Assistant
Administration
Supervisor
Physician
Email
example@example.com
Phone Number
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Female
Male
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long do you plan on volunteering?
Please Select
6 months
1 year
2 years +
Languages fluently spoken in addition to English
Are you a health care worker? If so, please specify your role (i.e. medical assistant, nurse, EMT, etc)
Any additional comments you'd like to share about yourself that you'd like the SAANTX clinic to know?
Submit
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