Volunteer / Internship Application

Minority Health Consortium, Inc.

Volunteer Application Form
The mission of the Minority Health Consortium is to raise the general level of health of minority persons in the Richmond metropolitan area through participatory strategies that enhance healthier lifestyles, with the involvement of the community, public and professional organizations, and interested citizens.

We encourage the participation of volunteers who support our
mission and are willing to contribute. The information provided through this form will be confidential and will help us determine the
most satisfying and appropriate volunteer opportunity for you.
Name*

PrefixFirst NameLast Name
Birth Date*

MonthDayYear
Email*

Confirmation Emailexample@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Pronoun:*

Minority Health Consortium, Inc.