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Volunteer Application

 

First Name *

Last Name *

Date of Birth *

Street Address *

City *

State *

Zip *

Home Phone *

Cell Phone

Work Phone

Email *

How did you hear about VIM?

Education

High School

Technical

Undergraduate School

Degree

Medical/Nursing

Specialty

Other Education

Medical License Number
(Please attach a copy of your medical license. Acceptable file formats: PDF, TIF and JPG.)

Driver's License Number
(Please attach a copy of your driver's license. Acceptable file formats: PDF, TIF and JPG.)

Volunteer Activity(s) desired (Check all that apply.) *

Special Skills and Availability
Languages spoken

Other skills/training

Hours available (Check all that apply) *

Please list any special needs that you have to ensure your safety and the safety of others.

In case of emergency
Person to contact

Relationship

Home phone

Cell phone

Work/Volunteer Experience
Please list any organizations that you have worked for, starting with the most recent.

Organization Dates Responsibilites

I attest that all information provided on this volunteer application form is to the best of my availability and believe true, correct and complete.

Signature *

Please note that an electronic signature is acceptable.

Date * (mm/dd/yyyy)

Grossmont Healthcare District Honors Healthcare Hero Volunteers

May 20, 2012 (East County Magazine) — Two volunteer physicians, two members of a community service club and a hospice volunteer were among this year’s recipients...

 
Latest status update here.

Latest status update here.

COME GARDEN WITH US! We have a patient/community garden where we grow vegetables and fruits.  It is a wonderful experience to learn how to grow your own food and...

 

Ensuring care for uninsured

San Diego Union Tribune, November 2006 By Anne Krueger STAFF WRITER November 11, 2006 EL CAJON – Ken Bagley hadn’t visited a doctor’s office in decades....

 

Physicians plan debut of clinic for uninsured

San Diego Union Tribune, May 2005 By Anne Krueger STAFF WRITER May 2, 2005 EL CAJON – They’ve got the doctors, they’ve got the equipment and they’ve...