Thank you for your interest in volunteering at Christ Clinic.*

*Christ Clinic is a charity clinic. Provider shadowing opportunities are limited.


NOTE: Nursing students please apply to the GNE Placement Program through your college or university.


* Required Fields
Contact Information
* First Name 
* Last Name 
* Address 
  Address 2 
* City 
* State/Province 
* Zip/Postal Code 
  Home Phone 
  Cell Phone 
  Work Phone 
* Email 
* Date of Birth 

Volunteer Information
  How did you hear about us? 
  Describe your reasons for volunteering at Christ Clinic? (school, professional or personal) 
  Clinic hours are M - F; 9am - 5pm. What days and times are you available? 

Skills and Experience
  Are you bilingual (English/Spanish)? 
  Describe your medical experience 

Privacy Policy
We keep your personal information private and secure. When you submit this form, your name, contact information, and any additional information will be available only to our organization.

Contact Us: Organization Name •• Street Address, City, State  ZIP Code •• Phone •• Email

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