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2020 TB Free Chuuk Volunteer Form - Final

TB+Leprosy Free Chuuk
Volunteer Form
Thank you for considering a volunteer mission to Chuuk.  
Please enter your contact information below.
Check all certifications and credentials that apply.
How many years of TB program experience do you have?
Which of the healthcare-related skills listed below do you have? Check all that apply.
Have you lived or worked overseas for more than 1 month?
 If “yes,” for how long?                                 
Which volunteer groups do you prefer to join?
Rank them from 1 to 10, 1 being your 1st choice, 2 being your second choice, etc.
Please select each ranking number only once--there should be only one "1" entered, one "2" entered, etc..
Please provide a rank ONLY for the groups you are able and willing to join.
NOTE:  Start and End travel dates may shift slightly due to flight arrangements.
Space Cell 12345678910N/A
Group A – Arrive Chuuk on March 9, Depart Chuuk on April 1
Group B – Arrive Chuuk on March 30, Depart Chuuk on April 22
Group C – Arrive Chuuk on April 20, Depart Chuuk on May 13
Group D – Arrive Chuuk on May 11, Depart Chuuk on June 3
Group E – Arrive Chuuk on June 1, Depart Chuuk on June 24
Group F – Arrive Chuuk on June 22, Depart Chuuk on July 15
Group G – Arrive Chuuk on July 13, Depart Chuuk on August 5
Group H – Arrive Chuuk on August 3, Depart Chuuk on August 26
Group I - Arrive Chuuk on August 24, Depart Chuuk on September 16
Group J - Arrive Chuuk on September 14, Depart Chuuk on October 7
1. If your requested time is full, are you willing to be placed on a list to serve as a back-up volunteer to step in for cancellations, family emergencies, etc?
This is hard work, and most volunteers are exhausted after their three-week volunteer mission.  For this activity, preference may be given to those who are willing to work in Chuuk for a longer period of time. 
3. If you can extend your time in Chuuk, please enter below your possible arrival and departure dates between March 9 and October 7. 
Space Cell Arrival DateDeparture Date
Group A
Group B
Group C
Group D
Group E
Group F
Group G
Group H
Group I
Group J
Thank you for completing this form.