Email form coming soon
Health for Life / Salud Para Vida Program
APPLICATION FOR HEALTH FOR LIFE DEVELOPMENT TEAM
Please help us learn about you, your reasons for volunteering, and your ideas about how you can contribute to VIDA's efforts on behalf of the worlds children.
When you have completed this form, please mail it to our office. We prefer you digitally infill the form (adding whatever space you need), saving the file with a new title and emailing the file back to us at email@example.com. Thank you.
HEALTH AND MEDICAL PROFESSIONALS
Telephone: Daytime: Evening:
FAX Number (if available):
Age: Marital Status:
Please attach a copy of your current curriculum vita, certifications, and appropriate licenses to this application.
Please tell us a little about yourself and your background:
Please indicate what professional services you would be willing to contribute to our Health for Life program:
( ) Direct services in my speciality:
( ) Continuing education and lecturing in my field
( ) Support services to in-country professional staff
( ) Serve as a member of a prescreening team
What skills or life experiences do you have that might help you as a member of our Health for Life Development team:
Why are you interested in working as a volunteer with VIDA?:
Please share with us some ideas of how you can contribute to VIDA's Health for Life program:
Have you ever traveled outside of the United States?: ( )
If so, where, when, and for what purposes?:
Do you speak any foreign languages?: ( ). If so, please list:
Do you have a country (countries) to which you might prefer to travel?:
If so, why?:
Is there any country to which you would prefer not to travel?: ( ). If so why":
Do you have any specific health problems that require special considerations (e.g., special diet; physical challenges) or for, which. you take medications on a regular basis?:
Thank you for your time and thoughtfulness in completing this application. Please note that all of VIDA's Health for Life Development Teams are volunteers, and members travel at their own expense. This application does not guarantee a place on any development team. The information supplied on this application enables VIDA to select those volunteers who would best meet the needs of a specific project. Thank you for your interest in our Health for Life program.