VOLUNTEER APPLICATION

Fields marked with an * are required

Volunteer Application

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Emergency Contact Information

  • Availability

  • Authorization and Achnowledgements

    Please read the following statements carefully and indicate your understanding and acceptance by responding in the affirmative in the space provided. I certify that all the information in this application is true and correct, and I further understand that any misstatement or omission of information may be grounds for disqualification or immediate dismissal. By checking the box below you are providing an electronic signature confirming your understanding of, and agreement with, all terms and conditions stated above.
    After submitting your application, the Volunteer Coordinator may contact you to discuss our available volunteer opportunities. Due to the high volume of applications, not all applicants will be contacted. If you have not been contacted within four weeks of submitting your application, please assume that you have been unsuccessful on this occasion.

FTCA

As a Federally Qualified Health Center (FQHC), HOPE receives HHS funding and Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

HOPE Clinic is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

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