info@wausaufreeclinic.com (715) 869-4922

Volunteer Today

Volunteer

Community Volunteers!

Sign-up to make a difference today.

Application instructions for community members in and around Wausau: Please fill out the application via the button below.

Volunteer Application

First Name

Last Name

Date of Birth

Address

Address 2

City

State

Zip

Phone

Preferred mode of contact

Phone
Email

Occupation/Job Title

Employer

How did you learn about volunteering at the Wausau Free Clinic?

Friend
Newspaper
TV/Radio
Community Group
Website
Other

Education: Check all that apply

High School
Associate
College-Bachelors
Graduate Degree

I give my consent to a general background check, if required.

Service Provider Qualifications

MD/DO
PA
Pharmacist
Pharmacy Technician
NP/APN
Social Worker/Licensed MH Professional
Other

Medical Intake/Discharge qualifications

RN
LPN
MA
Medical Student
Student Nurse
N/A

Clinic Support Experience

Receptionist
Records Support
Social Support
Patient Advocate/Insurance Navigator
Marketing/Newsletters
Fundraising
Grant Writing
Computer Work
Direct Mailing

Talents and skills you wish to share

When are you available? Current clinic hours are Thursday 1pm-5pm

Translator Please specify language(s).

References

Personal Reference

Reference Contact

Relationship to you

Professional Reference

Reference Contact

Relationship to you

I certify that the information contained in this application is true and complete to the best of my knowledge. I acknowledge that any misrepresentation, falsification or omission herein shall be sufficient reason for dismissal from or refusal of volunteer services.