Site Application

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Volunteer and Retired Providers Program Site Application

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.

Participation in the VRP Program requires affirmed compliance with state and federal civil rights protection against discrimination on the basis of race, color, national origin, age, disability, sex, creed, gender, gender expression or identity, sexual orientation, marital status, religion, honorably discharged veteran or military status, or the use of a service animal by a person with a disability. You must also affirm that participation in religious activity is not required for individuals to receive healthcare services from your organization.


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.