ROMP 2023 Volunteer Programs

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Please complete this form to apply to volunteer in a ROMP 2022 Volunteer Program. Once you have submitted your application, we will review it and let you know if you have been selected. We will send you a link to a Classy profile where you can make the deposit of $100 in order to formally enroll in the program and begin fundraising. If you have any questions, please direct them to volunteerprograms@rompglobal.org

Which program do you plan to attend? *

10-19 February 2023 in Guatemala

24 March-2 April 2023 in Ecuador

14-23 April 2023 in Guatemala

19-28 May 2023 in Ecuador (ONLY COLORADO STATE UNIVERSITY)

7-16 July 2023 in Ecuador

21-30 July 2023 in Guatemala

2-10 September 2023 in Ecuador

13-22 October 2023 in Guatemala (FULL! Waitlist only)

10-19 November 2023 in Ecuador (Spots available!)

First name *

Last name *

Gender *

Female

Male

Prefer not to say

Mailing Address *

City *

State *

Zip Code *

Primary Phone Number *

Alternative Phone Number *

Email address *

Do you have/will you have a passport that will be valid during the program you selected? *

Yes

What is your profession or current training program? *

Prosthetics and Orthotics

Physical Therapy

Occupational Therapy

Physical Medicine and Rehabilitation

Public Health

Social Work

Engineering, Design, Innovation

Other:

How did you find out about ROMP Volunteer Programs? (Check all that apply.) *

Through my academic institution or training program.

Through a ROMP email or social media.

Through a professional conference or publication.

I have volunteered with ROMP before.

Through my place of work.

Through my participation in the ROMP Components for a Cause Program.

Through my participation in the ROMP US Assistance Program.

Through my participation in Climbing or Moving for ROMP.

Other:

Required

If you are currently working, what is your employer and job title?

If you are currently working, how many years of experience do you have?

Please describe any prior international volunteer experience you have.

Please describe any professional specialties or special skills you have.

Please list any languages other than English that you speak, and your level of proficiency in each language.

T-Shirt Size *

Mens small

Mens medium

Mens large

Mens X-large

Mens XX-large

Womens X-small

Womens small

Womens medium

Womens large

Womens X-Large

Dietary Preference/Allergies *

Vegetarian

Vegan

Kosher

Halal

Gluten-free

None

Other:

Full name of emergency contact *

Relationship with emergency contact *

Address of emergency contact *

City of emergency contact *

State of emergency contact *

Zip code of emergency contact *

Primary phone number of emergency contact *

Alternative phone number of emergency contact *

Please read the Volunteer Waiver, and digitally sign in the space that follows using your full name. Please note that your digital signature constitutes your true signature. *

Please select today's date to sign for the volunteer *

YYYY

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