College of Health and Human Services


 

KSU Community Clinic Volunteer Application

 

Name:       
Mailing Address:   Apt #, etc.
City:   State:
Zip:    
Email:   Phone:
     

Affiliation with KSU:

Student

Alumni

Community member

Other

 

Areas of Interest/Expertise

Clinical

Clerical

Administrative

Other

 

Professional License
  No.

 

Languages Spoken:

Days and Hours Available:
Can you volunteer on an "as needed" basis? Yes.
  No.
Thank you for your interest in the KSU Community Clinic