Site Application

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Volunteer and Retired Providers Program Site Application

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Thank you for your interest in participating in the Volunteer and Retired Providers (VRP) Program as an approved site. The following documentation is necessary to ensure your site meets all requirements of the law in order to be eligible for malpractice and license renewal support for your volunteers in Washington State.

You may save your progress and complete this application at a later date by clicking "Save and Resume Later" at the bottom of any page.

If you have questions about this application, please contact us at 267-713-9422 or vrp@wahealthcareaccessalliance.org.

CONTACT INFORMATION










Name of Individual Completing this Form





Organization Profile




Please upload appropriate documentation below.

Organization Profile, Continued






Confirmation and Submission


The VRP Program surveys all affiliated VRP sites and VRP providers on an annual basis to track the value of this publicly-funded program. We ask that you complete a survey on behalf of your organization and assist us in reaching out to providers to ensure they too respond to the survey.