| The information you provide on this form will help us to create the best Volunteer Corps community and opportunities for you. Rest assured that your information will never be shared with any third parties! |
|
 |
|
name (first and last) |
|
|
|
mailing address |
|
|
|
city |
|
state |
|
|
|
zip code |
|
|
|
|
|
phone |
|
email |
|
|
|
date of birth |
|
|
|
|
|
| Which Curamericas Global Expedition(s) were you a part of? (Please list the year, location, name of your group, type of work you participated in, etc.): |
|
|
|
|
|
| Please select your current occupation: |
|
Medical/Health Student
Student in another field (non-medical/health)
Medical/Health Professional or Retiree
Professional or Retiree from another field (non-medical/health)
Other
|
|
|
|
| What is the name of your organization or school (if applicable)? |
|
|
|
|
|
| Please provide a brief description of your occupation (such as: job title or educational level; field of study or expertise; etc.): |
|
|
|
|
|
| What made you decide to volunteer overseas with Curamericas Global? |
|
|
|
|
|
| Would you be interested in volunteering overseas with us again?
*If "yes", please visit our volunteer page to find out about current opportunities and to fill out an interest application!
|
|
Yes No Maybe |
|
|
|
| What type of opportunities, webpage features, events, etc would you like to see offered by the Volunteer Corps? We'd love you hear your ideas!: |
|
|
|
|
|
| Would you be interested in helping to get others involved with Curamericas Global by sharing information with your community, school, church, service club, etc.? |
|
Yes No Maybe |
|
|
|
| comments |
|
|
|
|
|
|
|
