CIOGC Covid-19 Vaccine Volunteer Form
CIOGC is working with local departments of public health to offer the Covid-19 vaccine potentially at various Masjid locations.  We are recruiting medical and non-medical volunteers to assist with this effort.  If you are interested in volunteering please fill out this form.  Once our vaccination site is confirmed we will send out an online form to register for volunteer shifts.  

We ask volunteers to commit to a full 4 hour shift.  Tentatively, vaccination will be offered on Saturdays/Sunday.

Non-medical volunteers will assist in patient registration and serve as ushers

Medical volunteers will serve as vaccinators and observe patients after vaccination.  Medical volunteers must have an active license in the State of IL (Nurses, nurse practitioners, physician assistants, physicians, dentists, pharmacists).  Licenses will be verified.
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Phone number *
Gender *
Medical/Non-Medical Volunteer *
Which location are you willing to volunteer at? Can select more than one location. *
Required
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy