Volunteer Application Form

Name: *

Date:

Home Address: *

State:

Zip Code:

Date of Birth: *

Phone: *

Citizenship/Passport Country:

E-mail address: *

Emergency Contact

Contact Name: *

Relationship: *

Phone #: *

Professional Occupation:

Current Employer:

Previous Work Experience:

Previous Volunteer Service Experiences:

Highest Level of Education:

Name of Professional Reference:

Phone number:

Which program are you interested in volunteering with?

Please detail your skills here:

Non-medical/educational professionals Skills or Special Interests (e.g. art, photography, music, writing, computer, event planning, etc.) can you contribute as a volunteer?

I am interested in helping in the office: Check all that apply.

I can help with event set up

I can provide administrative help from organizing files to stuffing envelopes

I'm great with numbers and data analysis

I'm detail oriented and I love research projects

I can help share digital content and assist with social media

I'm a photographer/videographer

I'm available to volunteer 8 – 10 hours a week

I'm available to volunteer 0 – 15 hours a week

I'm available to volunteer 15 – 20 hours a week

Accountant specialized in Non Profit Sector

Media Marketing

Social Media Coordinator

Grants Writer

Recruitment Coordinator

Fundraising Coordinator

Have you ever participated in a medical mission?

Yes

No

What Organization did you volunteer with and where did the organization go?

Length of the mission?

Have you ever applied to volunteer with H.E.R.O?

Yes

No

Have you ever participated in a mission with H.E.R.O?

Yes

No

Which program did you volunteer with?

How many missions have you volunteered with?

What was the date of your last mission?

Are you available for medical mission in March, August or Both?

What week(s) are you available for the literacy program?

Do you have any medical conditions?

Do you have any seasonal or medication allergies?

Do you have any dietary restrictions?:

For Educators Only*

What professional certification do you have?

What is the primary grade level you teach?

How long have you been an educator?