Sign Up as a Volunteer

Volunteer Information

             


*City

At least one (1) telephone number is required.

Dental, Vision and Nursing students, please indicate the following in the COMMENTS box: professional track (Dentistry, Dental Hygiene, Dental Assistant, Optometry, Ophthalmology, RN, etc), your school, and what year you are in your program of study (1st, 2nd, 3rd, FINAL, etc.).

ATTENTION STUDENTS: Advanced, senior-level dental, vision and nursing students may be involved in certain levels of patient care. To volunteer as a supervised student in an area requiring licensure, you must have school sponsored supervision in the form of a faculty licensed practitioner.


License Information (if applicable)

License Expiration Date
Do you currently or have you ever had health sciences licensure in another state?

Please use this space for health professional licensure
information only.


Please DO NOT enter driver's license information!!


Profession


Please use the Job Title space to tell us your Job Title or Career, i.e., teacher, administrative assistant, professor, engineer, etc. This information can help us identify duties for you at the clinic!

ATTENTION STUDENTS:
YOU MUST BE ENROLLED IN A
HEALTH PROFESSION DEGREE PROGRAM
IN ORDER TO REGISTER AS A
DENTAL, VISION, OR NURSING STUDENT -

simply click your field of study and select the
correct student category.

IF YOU ARE AN UNDERGRADUATE STUDENT IN
A PRE-DENTAL, PRE-OPTOMETRY, OR
PRE-MEDICAL PROGRAM OF STUDY,
AND YOU HAVE NO OTHER HEALTH LICENSURE
OR CERTIFICATION, CLICK SUPPORT IN THE
CATEGORY LIST BELOW AND REGISTER AS
GENERAL SUPPORT.
  • Airborne
  • Dental
  • Medical
  • Support
  • Veterinary
  • Vision