Volunteer Application

Fill out the form below to apply to volunteer with Bingham Family Clinic. Looking to volunteer as a clinical provider instead? Use theprovider application.

Personal Information

Full Name *

Email *

Phone *

Are you a service missionary for The Church of Jesus Christ of Latter-day Saints?

If current student…

School / Organization

Experience

Approximately how many direct patient care / clinical hours have you completed?

Tell us about any previous healthcare, leadership, work, or volunteer experience that would help us place you in the right role.0 / 100 words

Shift Availability

Select all shifts you're available for.

Day	10-2	2-6
Mon	Mon 10-2	Mon 2-6
Tue	Tue 10-2	Tue 2-6
Wed	Wed 10-2	Wed 2-6
Thu	Thu 10-2	Thu 2-6
Fri	Fri 10-2	Fri 2-6

How long do you expect to volunteer? *

Referral Source

How did you hear about Bingham Family Free Clinic? *

Resume (Optional)

Upload Resume (PDF or Word)

Choose FileNo file chosen

Volunteer Application

Application Submitted