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Encore Intergenerational Vaccine Corps 

Volunteer Application

Thank you for your interest in the Encore Intergenerational Vaccine Corps. Community Health Centers in the Bay Area will benefit from your help. In addition to serving at a health center or in the community, a unique aspect of this opportunity is getting to know other volunteers of all ages. Please complete this form to allow us to best match your skills and desire to help with the needs of Health Centers.

When you are satisfied with all your responses, click the "Submit" button at the bottom. You will be taken to an e-signature page where you may review your application and edit if necessary. You will also have the option to print your completed application. Please click "Confirm". Once you have confirmed, you will be sent an email to verify your e-signature. Your information will be added to our database for review and consideration. Thank you!
Contact Information

Demographic Information
Encore.org is often asked to provide demographic information pertaining to volunteers and program members to our funders. We only share  anonymous and aggregated demographic information with funders. Please provide the following information. All fields are optional except age range, which is a requirement for some of our programming.

Emergency Contact Information

Medical Professionals
If you are a physician or medical professional (current or retired), please answer the following questions. 

Resume/CV (Optional)

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