Non-Physician Clinical Volunteer Application

This particular form is specifically for health care workers who provide direct care to patients, are not physicians, and who have licensed medical certifications e.g. RN’s, CRNA’s, APRN’s, LPN’s, etc or who provide some level of clinical care but are not licensed providers i.e. CNA’s, Scrub Tech’s, etc. All other individuals who work in a healthcare setting, including medical students, but do not fall into the above two categories should complete the ‘General, Non-Clinical Volunteer Form.’