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Symba Center Clinic - CW Volunteer Form
Thanks for taking the time to fill out the Clinical Volunteer Form for Symba Center's Clinic at Crosswalk Church - Redlands. The Clinic is open from 6-7:30PM every
second and fourth Thursday of the month.
If you would like to volunteer for the Lovewell Dinners, please click
HERE
.
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* Indicates required question
Volunteer Type:
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Non-Clinical Volunteer
Clinical Volunteer (All clinical volunteers will have to go through a certification process)
Required
First and Last Name
*
Your answer
Street Address:
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Your answer
City, State, Zip Code
*
Your answer
Primary Phone Number:
*
Your answer
Email Address:
*
Your answer
Current School/Program/Workplace
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Your answer
Level of Education:
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Current Student
Associate's
Bachelor's
Master's
P.h.D.
Medical Doctor
Nurse
Pharmacist
Physical Therapist
Other:
Medical Specialty, If Any: (If none, please reply with "N/A")
*
Your answer
Please Provide Your License Number, If Not Applicable Please Reply with "N/A":
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Your answer
Availability: (The clinic will be running every second and fourth Thursday of the month starting in August 2022)
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Regular Basis
Occasionally
Call Me When You Need Help
Required
Do you have any previous volunteer experience? If yes, please explain below.
*
Your answer
Are you a member of Crosswalk Church?
*
Yes
No
I am not affiliated with the Adventist Church.
Required
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