GW Health COVID-19 Volunteer Registration
Thank you for registering as a volunteer.

The current public health crisis is evolving daily, and our community partners are working diligently to provide needs assessments for volunteers. We will be in touch as we identify opportunities to serve safely and effectively. We know that there will be many in the days and weeks ahead. We appreciate your patience and your continued commitment to helping.

Thank you for your participation,
GW Health COVID-19 Response Task Force
Email *
Last Name *
First Name *
GW Affiliation *
Primary Member Type at GW *
If a Student, select your degree program below. Select "N/A" if not applicable. *
If Faculty or Staff, what is your Department and/or Office. Example: Prevention and Community Health (N/A if not applicable) *
Skillset: Administrative (e.g. data entry and management, call handling, project management, supply chain, healthcare administration, interviewing) *
Skillset: Technical (e.g. contact tracing, infectious disease knowledge, micropipette skills, epidemiology training, database development, RNA extraction/cDNA synthesis, PCR amplification) *
Skillset: Preparedness: (e.g. project management, supply chain, general preparedness, first responder) *
Skillset: Clinical (e.g. triage experience, first responder, general clinical) *
Are you a licensed clinician (e.g. RN, NP, MD) *
What type of license do you have (e.g. RN, EMT,) *
In what state or territory are you currently located? *
In what city are you currently located? *
Are you available for on-site or remote opportunities? *
Do you have access to private transportation? *
If you are currently volunteering elsewhere, please let us know about the great work you are doing! Please share the organization name here. (N/A if not applicable) *
Do you want to be removed from our volunteer database? *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of The George Washington University. Report Abuse
Google Forms