Volunteer Request Form

Our Policy

It is clinic policy to provide equal opportunities without regard to race, color, religion national origin, gender, sexual preference, age or disability.

As a volunteer-based 501c3, we rely on the kindness of our licensed and non-licensed volunteers to provide quality healthcare services or support to the uninsured low-income residents of Broward County. It’s our goal to best match your skill set(s) to our current needs. Should there be a possible match, we will contact you to further discuss how we may work together and if licensed, invite you to complete a licensed volunteer application.

Thank you for completing the form below and for your interest in volunteering with the Light Of The World Clinic. Together, we can.

PERSONAL INFORMATION






SKILLS AND INTERESTS

What type of volunteer work are you interested in? Please check all that apply.



Other than English, do you speak other languages? If yes please indicate language and proficiency


EXPERIENCE


AGREEMENT AND SIGNATURE

By submitting this form, you affirm that the facts set forth in it are true and complete. You also understand that if accepted as a volunteer, any false statement, omissions or other misrepresentations made by you on this form may result in immediate dismissal.