Volunteer Application

About You

Are you a returning volunteer?*

Yes, I’m returning
No, I’m a first-time volunteer

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Do you have a passport?*

Yes
No

Passport Country*

Country

Passport Expiration*

Profession, Language Fluency

Please select as appropriate: I am a*

Specialty

If a student, please select:

Professional school
Undergrad
High School

Please indicate your level of proficiency in Spanish*

Bilingual
Fluent
Conversational
Basic
None

Please indicate your level of proficiency in Haitian Creole*

Bilingual
Fluent
Conversational
Basic
None

Volunteers must have completed at least their junior year of high school. Somos Amigos Medical Missions (R) does not provide specific supervision for minors; the experience provided by Somos Amigos Medical Missions (R) is not a structured international immersion program as might otherwise be available to high school students.

Name of the person who referred you to our organization

First Last

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Referral Source

This field is used for specifying the referral source or campaign. For example, volunteer email appeal.

Availability

Upcoming trip in which you are interested in volunteering*

January
April
July
October

If your participation is confirmed, you will be asked to sign and return a Volunteer Release form, as well as agree to abide by organization’s policies and procedures. In order to comply with Dominican Public Health requirements, at least six weeks before the trip, dentists and physicians will be required to provide a legible digital copy or image of a current license to practice, passport “face” page, and diploma from professional school.

Additional Message

CAPTCHA

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CC Contact Type

#HelpUsHeal by Volunteering!

About You

Profession, Language Fluency

Availability