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Healing Hands For Haiti

 Donnez a Haiti maintenant pour nous aider à reconstruire...



Rehab Medical Volunteer Application Form

Thank you very much for taking the time to offer to volunteer with Healing Hands for Haiti International.

The next step is to identify those who have skills, experience, and availability. Please complete the information below. We'll work with our volunteer groups and partners to schedule the appropriate personnel to effectively respond to the needs identified.

Please complete the entire volunteer form, review carefully and submit.

Contact Information

Preferred Contact Method


If your field of expertise is not listed below, please complete our 'Non-Rehab Volunteer' application form.

License Number



Required documents

File Size: 500KB Maximum

File Types: .doc .pdf .txt


File Size: 500KB Maximum

File Types: .doc .pdf .txt


File Size: 500KB Maximum

File Types: .doc .pdf .txt


We need to know your approximate dates of availability so we can plan for and fulfill our vacancies. For example, if you would like to travel to Haiti for 2 weeks in mid March 2011, then select 'March', '2011', 'Second Week', and '2 Weeks'.  Your application will then be used to fill needs in this period.  Our Volunteer Coordinators will contact you and work with you to select your final dates of availability. The need in Haiti is constant throughout the year, however, some periods are more popular than others for our volunteers. Traditionally the period from mid-January to April has the most applicants.






* Required

Copyright 2015 by Healing Hands for Haiti, Active Pro-bono Support from Augeo+Greer
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