Volunteer Application

Become a Volunteer

Each year volunteers travel at their own expense and raise money to support travel and the cost of supplies in addition to their vacation time donated. For some, this might be their first year, for others they are returning for their tenth trip. But for all involved- it is life changing. Help us by becoming a volunteer to help save the life a very deserving patient!

Volunteer Application Form

Name*
Prefix First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email
Home/Mobile Phone*
Work Phone
Easiest way to be reached*
- Email
- Home/Mobile Phone
- Work Phone
Qualifications*
Experience*
Position Applied for in Team*
Date Available*
Date of Birth*
Passport Nationality*
Passport Number*
Passport Expiration Date*
Next of Kin Name*
Next of Kin Number*
Next of Kin Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Medical History and Current Treatment*
Professional Registration*
Current Registration Number*
Current Registration State*
Up-to-Date Resume
Drop files here or

Accepted file types: jpg, png, pdf.
Copy of Medical License and/or Certifications
Drop files here or

Accepted file types: jpg, png, pdf.
Original Medical or Nursing Degrees
Drop files here or

Accepted file types: jpg, png, pdf.
Personal References
Drop files here or

Accepted file types: jpg, png, pdf.
How to Apply
Include with this application an up-to-date resume, copies of your current registration, original medical or nursing degrees, if medical personnel and personal references page. All portions of application must be submitted in order for processing.
AGREEMENT
If selected to be a member of this team, I understand decisions are made according to the regulations set forth by the organization and in adherence with the hosting facility the best interest and safety of the team. I accept the responsability of working as a Team Heart Member and agree to cooperate with the decisions of the Team Heart leadership and coordinators for care guidelines and scientific inquiry. There will be a non-refundable administrative fee of $100 upon acceptance to any Team Heart Medical Trip.
Electronic Signature*
Date of Application*
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"I am thankful to Team Heart for saving my life and allow me to return to my studies energetically and it does me proud to be studying public health"

TEAM HEART PATIENT

“I consider being a part of Team Heart to be the biggest achievement in my nursing career, and one of the best parts of my life!”

KRISTIN CALHENO RN

“After I returned from Rwanda, each time I passed my to do list, my pencil hovered to cross off Rwanda--I could not do it. Rwanda was not finished.”

MARIA STEELMAN 2012

"Rwanda can eradicate rheumatic heart disease in a generation-it is an achievable goal"

DAVID WILSON

DONATE NOW

Become a Volunteer

Volunteer Application Form

How to Apply

AGREEMENT