Volunteer Application

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Country of Citizenship (Passport)*

Country

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

Please select as appropriate: I am a*

Specialty*

If a student, please select:

Professional school
Undergrad
High School

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

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.

Take a Trip

Enciano Antonio