Tulane Community Health
Volunteer With Us |
| Thank you for your interest in volunteering with the Tulane University Community Health Centers. If you are looking for a rewarding experience or a way to renew your commitment to help rebuild the New Orleans community, our team of Physicians and Staff invites you to help us serve our patients and their families. To become a part of our volunteer team, please complete the general information below. Please allow three to five working days for processing and placement.For Questions and Comments, Contact Natalie Cooley: ncooley@tulane.edu |
Name (First Last)
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Email
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Address
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City
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State |
Zip Code
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Work Phone
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Cell
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| Why are you interested in volunteering at Tulane Community Health Center? |
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| In which areas are you most interested in working (check all that apply)? |
adult health care
pediatric health care
adolescent health care
direct patient interaction
administrative/clerical |
Do you have any transportation limitations?
Are there areas of the city in which you would not be able to volunteer? |
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What are your skills/strengths as relevant to the clinic?
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Medical
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Language
(please indicate fluency) |
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Clerical
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Other |
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How many hours per week would you like to volunteer?
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When will you be available to start?
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How long of a commitment can you make?
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Clinic hours:
Covenant House:
Monday, Tuesday, Thursday – 8 a.m. – 7 p.m.; Wednesday, Friday – 8 a.m. – 5 p.m.
New Orleans East:
Monday – Friday – 8:30 a.m. – 4 p.m.
What hours would you be available to volunteer? |
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| What is your highest level of education? |
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| Work/volunteer experiences: |
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| Have you ever been convicted of a felony?
no
yes |
| Emergency Contact Name, Relationship and Phone: |
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| Are you a Student?
no
yes - If no, skip to next section. |
| If yes, are you a medical student?
no
yes - If yes, what year?
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| Are you a Tulane student?
no
yes - If yes, what year?
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| What is your major?
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| If No, what is the name of your School?
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| Is volunteering a part of a class requirement?
no
yes |
| If yes how many hours are required?
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| Vaccination Requirements: Up to date vaccinations (check all that apply) |
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MMR
Tetanus
Hep B |
| Have you had a TB test done within the last 12 months?
no
yes |
| Any other questions or comments? |
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| Application Information Certification |
| Opportunities for volunteers are provided without regard to religion, creed, race, national origin, age or sex. The Tulane Community Health Clinic is not obligated to provide a placement, nor am I obligated to accept the position offered. I also understand that I will not be paid for my service. I certify the above information is true to the best of my knowledge. |
| I agree
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