Volunteer

First Name:*

Middle Name:

Last Name:*

Email:*

Address:*

City:*

State:*

ZIP Code:*

Phone number:*

Phone type:*

Date of birth:*

How did you hear about HMH?

What will most help you gain an appreciation of Haiti and its people?

What will most help you engage with the people with whom you will be working with?

What will most help you grow your abilities to be a competent, culturally aware, and compassionate citizen of global health?

What is your passion?

What can you contribute to HMH?

How does your passion align with HMH’s mission?

How do you like to make a difference?

What can you contribute before your Haiti trip?

What will you contribute after your Haiti trip?

Please verify:*

*I verify that all of the above information is true, complete, and correct, and I understand that if it is not, I am disqualifying myself for a volunteer/intern position. I also understand that I am applying for a volunteer/intern position and that this is not an application for, nor a contract of paid employment. I further agree that as a Health Ministries for Haiti volunteer, I will not accept any payment for my services. I will also take required training where applicable. I authorize any verification of applicable licensure if it is required for my volunteer position.

Health Ministries for Haiti

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