Who we are
Introduction
History
Staff
Clinic
Mission/ Vision
What we do
Clinic Services
Surgical Campaigns
Patient Stories
Future Projects
Current Projects
Past Projects
Get Involved
Volunteer
Shamrock Shuffle 8K
Volunteer Registration
Volunteer Application
Ways to Give
CMHP Volunteer Application
Thank you for your interest in Centro Medico Humberto Parra (CMHP)! To apply for a volunteer position with our clinic in Bolivia, please complete the following application.
Name
*
Email
*
Title
*
Select
Undergraduate*
Medical Student M1*
Medical Student M2
Medical Student M3
Medical Student M4
Nursing Student
Resident
Attending
RN
Nurse Practitioner
Physician Assistant
Physical Therapist
Other
Other Title
*If you are an undergraduate student or M1 student, please provide a paragraph describing the project or study you hope to conduct/focus on at CMHP, as you will not be able to volunteer in a clinical capacity yet. (You will still be welcome to shadow clinicians). Past students have done research studies on birth-spacing, nutrition, and Chagas as well as public health campaigns around sexual health, deparasitation, and first aid training.
Clinical Interest(s):
*
Select
Internal Medicine
Surgery
Pediatrics
Global Health
Public Health
Infectious Disease
Physical Therapy
Occupational Therapy
Affiliation with Institution:
Select
Northwestern University/Northwestern Medicine
Loyola University
UIC
U of C
Rush University
Lurie Children’s
OSU
Creighton
Mayo Clinic
Other
Clinical Specialty(s):
Other Institution Affiliations:
Level of Spanish-Speaking Ability
*
Select
None
Basic – know the basic words and tenses
Intermediate – can hold a conversation
Advanced – could give a presentation
Fluent – native speaker
Clinical Professional References (supervisors, colleagues, professors, etc.)
Clinical Professional References (supervisors, colleagues, professors, etc.)
Name:
*
Title
*
Email
*
Relationship
*
Divider
Name
*
Title
*
Email
*
Relationship
*
Divider
Name
*
Title
*
Email
*
Relationship
*
Travel Requests
Travel Requests
1. Preferred date of trip (approximate):
*
2. Preferred date of trip (approximate):
*
3. Preferred date of trip (approximate):
*
Are you hoping to travel with a friend, family member, colleague, etc.? If so, please list and explain here:
*
Additional Information
Additional Information
Did a former coordinator or volunteer tell you about CMHP or the Daniels Hamant Foundation? Please let us know who your connection is:
Please upload your resume/CV here (pdf, doc, docx):
*
Select files...
If you have any additional information to share or any questions for us, please outline here:
Thank you for taking the time to apply for a volunteer position at Centro Medico Humberto Parra. The North American Coordinator, Sarah Goldberg, will get in touch with you once your references have been contacted. If you have any questions or feel it’s taking longer than expected to get a response, please contact her at na.coordinator@hamantfoundation.org. Thank you!
Thank you for taking the time to apply for a volunteer position at Centro Medico Humberto Parra. The North American Coordinator, Sarah Goldberg, will get in touch with you once your references have been contacted. If you have any questions or feel it’s taking longer than expected to get a response, please contact her at na.coordinator@hamantfoundation.org. Thank you!
Who we are
Introduction
History
Staff
Clinic
Mission/ Vision
What we do
Clinic Services
Surgical Campaigns
Patient Stories
Future Projects
Current Projects
Past Projects
Get Involved
Volunteer
Shamrock Shuffle 8K
Volunteer Registration
Volunteer Application
Ways to Give