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Volunteer

VOLUNTEER AS A GLOBAL MEDIC FORCE CLINICAL MENTOR

Thank you for your enquiry.

Your application will be reviewed and we will contact you as soon as we are able to.

Global Medic Force.

Name*

Address*

Preferred telephone contact*

Email*

Degree*

Medical or Nursing License Number*

Country where you are licensed*

Has your license ever been revoked or suspended?*
No Yes
When would be your earliest time to participate in an overseas programme?*

Are there other dates later this year or next year that you would be available?*

If your dates are flexible, how far in advance would you need to be notified in order to be able to participate?*

How long is the maximum period of time you would be available to spend overseas?*
1 Month 3 Months 6 Months 1 Year Don't know
Do you have medical/nursing experience in developing countries?*
Yes No
If Yes please provide any details here

Do you have travel experience in developing countries?*
Yes No
If Yes please provide any details here

What is your area of medical speciality?*

Cardiology
Infectious Diseases (HIV, Malaria, TB)
Obstetrics and Gynaecology
Internal Medicine
Paediatrics
Emergency Medicine
Surgery
Other

What is your level of experience in terms of providing clinical care for patients?*
less than 3 years 3 years or above
Do you have any specialist training?*
Yes No
If Yes please provide any details here

Where do you currently work*

Are you affiliated with any teaching hospitals?*
Yes No
If Yes which one

How many patients do you see each week?*

How many patients does your clinic/department see each week?*

Do you have related teaching/clinical experience?*
Yes No
If Yes please provide any details here

Please attach a brief copy of your CV*


Do you have any additional information about your professional experience that is relevant?

Would you be comfortable in a location without electricity or running water (this is NOT a requirement to volunteer; you will not be sent to a location without electricity or running water unless you indicate that is something you are comfortable with)?*
Yes No
Where did you hear about Global Medic Force?
Colleague Online

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