Champaign County Christian Health Center

A ministry focused on bringing healthcare to those in need.

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Volunteer Application

Please fill out the following form to apply to be a volunteer. Make sure to review the descriptions of the volunteer positions and the handbook before applying.

Volunteer Application

Name

Phone Number

Address

Social Security Number

Do you accept text messages on your phone?(Email is the primary mode of contact for CCCHC. Text messages would be only for scheduling purposes or other urgent clinic business; for example, if we need someone to fill in for a late volunteer cancellation.)

Yes

Reference #1 - You must provide the name, phone number, and email of the reference as well as their relationship to you.

Reference #2 - You must provide the name, phone number, and email of the reference as well as their relationship to you.

In what area(s) are you interested in volunteering? ( If MEDICAL QUALIFICATIONS are listed by the position, you MUST have those qualifications to select it as an option.)

Hospitality

Spiritual Care

Food

Interpreters

Triage (Requires RN, LPN, CNA, EMT or MOA)

Social Work (Requires LCSW status or MSW degree in progess willing to work with LCSW)

Provider (Requires MD, APN, PA)

Nurse (Requires RN background)

Date of Birth ( Please enter DOB as MM/DD/YYYY)

Thank You for Applying! You will receive a followup email after your application is reviewed.

Our mission is to share the love of Jesus Christ to our neighbors in Champaign County by providing holistic, free, and quality health care services.

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PO BOX 5005, Champaign, IL 61825

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