Welcome to SHOW's Clinical Volunteer Application!

Deadline: April 10th, 2017
What is your first name? *

What is your last name? *

What is your current address? *

Street Address, City, State, ZIP Code
What is your cell phone number? *

Please provide emergency contact details below.

Emergency contact name *

Emergency contact phone number *

Relationship *

Why do you want to participate in SHOW, and what do you hope to gain as a volunteer?
(please keep below 200 words) *

Have you worked with SHOW in the past? If so, how? *

SHOW requires that all clinical volunteers attend each of their four required shifts, unless given one week’s notice of an absence. Please mark your availability on the following shift dates:

Please mark the clinic rotations that you are available for:

Team A- 5/20, 6/17, 7/15
Team B- 5/27, 6/24, 7/22
Team C- 6/3, 7/1, 7/29
Team D- 6/10, 7/8, 8/5

Undergraduate Clinical Navigator (for undergraduate/graduate students)

If you are selected as an undergraduate clinical navigator, you will be responsible for escorting patient throughout the clinic, maintaining an efficient patient flow, informing patient of special events and resources, and working with the clinical team to ensure quality improvement.
Health Professional Student Volunteers (for graduate students)

This team is composed of various health professional students responsible for assessment, formulating diagnoses, treatment planning, and evaluation of primary care patient problems.
What position are you applying for?

Please provide a link to your resume on Google Drive: *

Volunteer Requirements

Volunteer Requirements are based on your role within S.H.O.W.  Please note that Student Clinical Volunteers include any student who will be working with patients/clients. Student volunteers must be a student of ASU, NAU or U of A.

Once you have submitted your application and it has been reviewed you will be asked to submit documentation of the requirements listed below and may be asked to complete additional forms.  Please begin to gather this information in preparation.
Thanks for completing this typeform
Now create your own — it's free, easy, & beautiful
Create a <strong>typeform</strong>
Powered by Typeform