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Thank you for your interest in volunteering for Phoenixville Free Clinic! We ask that you complete this application as a first step to becoming a volunteer.
Volunteer Application (Non-Healthcare)
First Name
Last Name
Address
Email
Phone
Have you worked or volunteered at Phoenixville Free Clinic before?
Yes
No
If so, when?
Are you or any family member(s) currently served by Phoenixville Free Clinic?
Yes
No
Please tell us why you want to volunteer and what you hope to gain from the experience.
Please note any physical limitations.
Do you speak other language(s)?
Proficiency
Native speaker
Fluent
Conversational
What volunteer opportunities interest you?
Front desk/reception
Data entry
Marketing
Translation
Scheduling/records
Business or volunteer office
Facilities/landscaping
Please check the time(s) you are available:
8:45-noon
12:45-4:00
4:00-6:00 (when available)
Please check the day(s) you are available:
Monday
Tuesday
Wednesday
Thursday
Friday
What is your time commitment?
Six months
One year
School year
Summer
How often would you like to volunteer?
1 time per week
Several times per week
Every other week
Education/Degree
Year of graduation
Are you currently a student?
Yes
No
If yes, degree sought and major:
Anticipated graduation date
Last PPD test
COVID vaccination date
Have you ever been convicted of a crime?
Yes
No
If yes, please explain.
The information contained in this application is correct to the best of my knowledge.
Submit
Thanks for submitting!
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