MEDICORPS - How Can YOU Help?

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> Volunteering

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Sarah's leg is painfully deformed
from a childhood accident.

You can help her run again!

Volunteering

Anybody who has donated some of their own time to help others will always look back at their experience with pride and fulfillment. More so, volunteering in a different cultural environment under challenging condition can be a profound personal growth process, as so many Peace Corps volunteers have testified. Often the actual teaching is balanced or even outweighed by an invaluable learning experience.

Medicorps relies on volunteers for the successful conduct of its programs. We welcome dedicated individuals from the following fields:

Physicians
Primarily we look for board eligible/certified specialists who would want to donate a minimum of one week of teaching and hands-on training to their foreign colleagues. Physicians can choose the timing of their visits in mutual agreement with their hosts. We will aid the volunteers to coordinate the scope of their work before the scheduled visit so that both parties have a clear idea what to expect.

We also need all types of specialists for our Internet based medical relief network (MIRN). Such volunteers will receive requests for advice and consultations over the Internet with digital images of complicated cases in poor countries. Even though this type of help is given from home or office the volunteer may develop a close and rewarding relationship with their distant colleagues.

Nurses and allied healthcare providers
Again we place heavy emphasis on teaching and training for a minimum stay of one week on location. Specialty skills beyond basic qualification are desirable. Mutual coordination with the host country is essential.

As with physicians we offer Internet contact with colleagues in developing countries to help with advice, training and to share experience.

Medical Students
We can facilitate placement with other organizations involved in community outreach and education programs. Even if a student is not involved in direct patient care the exposure to a different culture and social environment can be a landmark experience in a young persons life.

Imaging Specialists
Medicorps places a heavy emphasis on documentation of its activities. Cameramen, still photographers and individuals with sound and lighting experience have the opportunity to visit exotic and challenging environments together with the medical volunteers. Own equipment is desirable.

At home we welcome directors, editors, screenwriters and other post-production specialists.

Non-medical Volunteers
Medicorps may have special needs for volunteers with varied backgrounds to help with its day-to-day activities, such as clerical functions, fundraising, translation, accounting, writing and publishing, public relations and more.

Salaries and Expenses

Due to our limited funding we cannot provide salaries or financial help with travel and accommodation. We can help you find the lowest fares and encourage the hosting institutions to provide room and board.

General Requirements

Volunteers should be aware of special hazards unique to foreign destinations. We will furnish a country profile; volunteers will have to make their own arrangements for visas and vaccinations. Health and accident insurance is strongly recommended, and a prior medical check-up is desirable.

Our volunteers need to be independent-minded and able to function adequately in unfamiliar environments. Open-mindedness and the ability to improvise will help greatly to enhance the experience.

All volunteers are required to submit a report of their activities and experiences to Medicorps. Medicorps will issue a certificate of service in return.

Volunteer Information Form

Please fill in all boxes and submit the form below; if a field does not apply type NA in the field.

Name: (first, middle, last)
Address:
City:
State/Prov:
Zip/Postal code:
Country:
Phone:
Cell/Pager:
Work:
Fax:
E-mail:
Citizenship
Birth Year
Profession
Specialty
Current Professional Status & Institutional Affiliation (academic, hospital, private practice, retired, etc.)

Other Related Teaching/Clinical Experience

Have you ever had a professional license revoked/suspended?
Yes No
If yes, please explain.

States in which you hold valid licenses/registrations

Education
Undergraduate: (Institution, Degree, Date, Area of Study)

Graduate: (Institution, Degree, Date, Area of Study)

Additional Education: (Institution, Degree, Date, Area of Study)

Internship/Residency: (If applicable)

Professional Affiliations
Please list all professional affiliations: :

Professional References All fields in this section must be completed to initiate volunteer placement. We encourage you to include the e-mail address of your references if possible. Also, please notify your references so they are aware that they might be contacted by a representative of Medicorps.
1) Name: (first, middle, last)
Title/Institution:
Address:
City:
State/Prov:
Zip/Postal code:
Office Phone:
Home Phone:
Fax:
Cell/Pager:
E-mail:

2) Name: (first, middle, last)
Title/Institution:
Address:
City:
State/Prov:
Zip/Postal code:
Office Phone:
Home Phone:
Fax:
Cell/Pager:
E-mail:

3) Name: (first, middle, last)
Title/Institution:
Address:
City:
State/Prov:
Zip/Postal code:
Office Phone:
Home Phone:
Fax:
Cell/Pager:
E-mail:

Experience Please list all prior national and international experience.
1. Country:	Date:	Sponsor:
2. Country:	Date:	Sponsor:
3. Country:	Date:	Sponsor:
4. Country:	Date:	Sponsor:
5. Country:	Date:	Sponsor:

Availability The amount of time I can volunteer would be: (select largest possible number)
2 weeks	1 month	3 months
6 months	9 months	12 months
other

Location
Specific region(s) of preference:
Country of preference:
Not willing to serve in:

Companions
I wish to be accompanied by:
Spouse (list name) Children (list ages) Other (list name) N/A

Would your companion be interested in serving in a volunteer capacity?
Yes No
If yes, in what capacity?

Your companion will be expected to join MEDICORPS and may need to complete a Volunteer Profile Form.

Emergency Contact Please list name of person to be notified in case of an emergency.
Name: (first, middle, last)
Address:
City:
State/Prov:
Zip/Postal code:
Office Phone:
Home Phone:
E-mail:

Other
How did you hear about Medicorps?
Completion of this form is the first step in the volunteer placement process and does not guarantee an assignment. You may be asked to submit additional documentation for particular requirements in some countries.

Volunteering with MEDICORPS
Briefly indicate why you are interested in volunteering with MEDICORPS.

MEDICORPS volunteers will demonstrate the highest standards of professional and personal conduct at all times. Sensitivity to cultural and social beliefs and practices of the host country should guide professional and personal behavior. Typing in your name, dating and submitting is equal to signing this document. Please consider joining MEDICORPS as a member. Your contribution will support our programs of assisting the less fortunate in this world.
Are you currently a member of Medicorps?	Yes No
Signature
Degree
Date
This form will be considered valid for one year from the date submitted.

Alternatively, you may print this form and FAX it to: 808.733.7808

MEDICORPS | 93 S Jackson Street, #6120, Seattle, WA 98104-2818 | email: medicorps@medicorps.org | FAX: 808.733.7808

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