Volunteer & Internship Form Personal Information:Full Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Fluent LanguagesEducation:Current Student*YesNoSchoolMajorMinorWork:Are you currently employed?*YesNoStatus:Full TimePart TimeRetiredOccupation (or previous if Retired)*Availability:MondayTuesdayWednesdayThursdayQuestions:How did you hear about CHCC?*Web searchSocial mediaCurrent or past staff member, volunteer or internOtherList any training, professional licenses and/or certifications you may hold.In a brief paragraph, explain what interests you about CHCC and why you would like to volunteer here.What skills can you contribute to the Clinic?List the specific volunteer role(s) that interest you (in order of preference).NameThis field is for validation purposes and should be left unchanged.
