Medical Mission Volunteers Form

Introduction
Contact Information
Experience and Background
Reference
Attestation

Volunteer Application Form

Thank you for your interest in Volunteering for a medical mission trip to Nigeria. Please fill out our form to request more information. Following your submission, you will receive an email confirming your submission and one of our Administrator will contact you. We value and appreciate your support.

Personal Information

First Name

Last Name

Date of Birth

Email Address

Gender

Phone

Home Address

City

State

Zip Code

T-Shirt Size

Passport Number:

Nationality:

Date of Expiration:

Emergency Contact:

Emergency Contact Telephone Number:

Professional Reference One

Reference Full Name

Reference Phone Contact

Reference Email

Professional Reference Two

Reference Full Name

Reference Phone Contact

Reference Email

Confidentiality Statement

By checking "I agree" in this document, I attest that the information submitted is both truthful and accurate to the best of my knowledge. I understand that in the course of my volunteer work, I may be exposed to information of a confidential nature pertaining to patients/families and will maintain the highest standards of confidentiality and uphold the Funmi Adewole Foundation policies and traditions to safeguard the rights of those we serve.

Agreement Statement

I agree

Providing free basic health care to underserved communities across Africa, supporting quality education in the continent through an education trust fund, and promoting cancer awareness initiatives in the United States and Africa.

Funmi Adewole Foundation is a tax-exempt 501(C)(3) non-profit organization.

Contact Details

For inquiries, partnerships, or caregiver opportunities, please contact us today.

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Thank You

Profile Data

Profession or Volunteer Classification

Professional Reference

Authorization and Consent

Volunteer Application Form

Personal Information

First Name

Last Name

Date of Birth

Email Address

Gender

Phone

Home Address

City

State

Zip Code

T-Shirt Size

Passport Number:

Nationality:

Date of Expiration:

Emergency Contact:

Emergency Contact Telephone Number:

Area of Interest

Please choose:

Professional Reference One

Reference Full Name

Reference Phone Contact

Reference Email

Professional Reference Two

Reference Full Name

Reference Phone Contact

Reference Email

Confidentiality Statement

Agreement Statement

Contact Details

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Request a Call-back

Volunteer Application Form