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Non-Medical Volunteer Form
Non-Medical Volunteer Form
Non-Medical Volunteer Form
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Days
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Hours
9:00 am - 1:00 pm (M, T, W, Th, F)
1:00 pm - 4:00 pm (M, T, W, Th, F)
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During the time I am in SC
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Months/Days:
On average, how many hours per week can you typically volunteer? (select best answer from dropdown)
3-5 hours per week
6-10 hours per week
11-15 hours per week
16-20 hours per week
20+ hours per week
Previous Volunteer Experience
Please Provide a Copy of Your CV or resume, if available (not a requirement).
Resume or Supporting Document
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Maximum upload size: 10.49MB
If you would like to submit a resume or supporting document, please upload here.
Interests
Interpreting
Front Desk
Appointment Reminder Calls
Data Entry
Clerical
Appointment Scheduling
Case Management
Pickups & Deliveries
Special Projects
Health Fairs
Fashion Show Event
Golf Event
Social Steward/ Outreach Visits
Sponsorship Soliciation
Other
Other
We need a variety of non - medical volunteers. Please check all duties that you would be interested in providing for BIFMC.
Can you commit to attending at least one outreach/health fair event per year? Typically these will occur on a Sat/Sun
Yes
No
Have You Ever Been Convicted of a Felony?
Yes
No
The Clinic requires all volunteers to undergo appropriate background checks. For non-medical volunteers, we check SLED. Please Provide A Copy of Your Driver’s License.
Person to Notify in Case of Emergency
Name
Address
Address
Address
Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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South Dakota
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Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Home Phone
Work Phone
Cell Phone
Email Address
By submitting this application, I understand that as a volunteer, I will give of my time and talents to the mission of the Barrier Islands Free Medical Clinic, Inc. to provide non-medical duties for the uninsured population of Johns, Wadmalaw and James Islands, without compensation. I agree to undergo all required background checks and to abide by current HIPPA legislation.
Where did you learn about Barrier Islands Free Medical Clinic?
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Newspaper/Magazine (please list)
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