OneSight Vision Clinic - Volunteer Interest Form

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* 1. Please fill out your information below:

First and Last Name

Organization or School volunteering on behalf

Email Address

Cellphone Number

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* 2. What days/times are you available/interested in volunteering?

Wednesday, June 26 8:30 a.m. – 1:30 p.m.

Wednesday, June 26 1:00 p.m. – 6:00 p.m.

Thursday, June 27 8:30 a.m. – 1:30 p.m.

Thursday, June 27 1:00 p.m. – 6:00 p.m.

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* 3. I am a ________.

Ophthlamologist

Optometrist

Optician

Other optically skilled Vision Professional

Medical Professional

Medical Student

Vision Student

General Volunteer

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* 4. Additional skills or notes:

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* 5. Do you fluently speak another language other than English, and would you be willing to assist with translation if needed?

Yes

No

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* 6. If so, please list what languages (other than English) you speak:

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* 7. Special accommodations? (e.g. limitations on standing, lactation room, dietary restrictions, etc.)