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.
First Name (required)
Last Name (required)
Zip/Postal Code (required)
Country (required) ArubaAfghanistanAngolaAnguillaÅland IslandsAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntarcticaFrench Southern TerritoriesAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBonaire, Sint Eustatius and SabaBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaSaint BarthélemyBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBouvet IslandBotswanaCentral African RepublicCanadaCocos (Keeling) IslandsSwitzerlandChileChinaCôte d'IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCuraçaoChristmas IslandCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaWestern SaharaSpainEstoniaEthiopiaFinlandFijiFalkland Islands (Malvinas)FranceFaroe IslandsMicronesia, Federated States ofGabonUnited KingdomGeorgiaGuernseyGhanaGibraltarGuineaGuadeloupeGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGreenlandGuatemalaFrench GuianaGuamGuyanaHong KongHeard Island and McDonald IslandsHondurasCroatiaHaitiHungaryIndonesiaIsle of ManIndiaBritish Indian Ocean TerritoryIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJerseyJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People's Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacaoSaint Martin (French part)MoroccoMonacoMoldova, Republic ofMadagascarMaldivesMexicoMarshall IslandsMacedonia, the former Yugoslav Republic ofMaliMaltaMyanmarMontenegroMongoliaNorthern Mariana IslandsMozambiqueMauritaniaMontserratMartiniqueMauritiusMalawiMalaysiaMayotteNamibiaNew CaledoniaNigerNorfolk IslandNigeriaNicaraguaNiueNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPitcairnPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People's Republic ofPortugalParaguayPalestine, State ofFrench PolynesiaQatarRéunionRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSouth Georgia and the South Sandwich IslandsSaint Helena, Ascension and Tristan da CunhaSvalbard and Jan MayenSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSaint Pierre and MiquelonSerbiaSouth SudanSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSint Maarten (Dutch part)SeychellesSyrian Arab RepublicTurks and Caicos IslandsChadTogoThailandTajikistanTokelauTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUnited States Minor Outlying IslandsUruguayUnited StatesUzbekistanHoly See (Vatican City State)Saint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, BritishVirgin Islands, U.S.Viet NamVanuatuWallis and FutunaSamoaYemenSouth AfricaZambiaZimbabwe
Primary Email (required)
Daytime Phone (required)
Daytime PhoneEvening PhoneMobile PhonePrimary EmailSecondary Email
If your field of expertise is not listed below, please complete our 'Non-Rehab Volunteer' application form.
Physician (PM&R)Rehab NursingPhysical TherapistOccupational TherapistCertified OrthotistCertified ProsthetistCertified Prosthetist & OrthotistP&O TechnicianWheelchair TechnicianSpeech Language Pathologist
Please add your complete professional license number and the issuing authority. You will be unable to work in Haiti without a valid and active professional license. If your field is not licensed (e.g. prosthetic tech) please add your area of expertise.*
Have you previously volunteered in Haiti?
With which organization?
Please select language(s) you speak. This means you can function in this language without translator assistance.
We require your resume to begin processing your application.*
We require one letter of reference to complete your application, but we prefer two.*
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.
Select the starting week in which you are available.*
First WeekSecond WeekThird WeekFourth WeekFifth Week
Indicate how many weeks you are available.*
1 week2 weeks3 weeks4 weeks5 or more weekes
Select the starting week in which you are available.
1 week2 weeks3 weeks4 weeks5 or more weekes
Indicate how many weeks you are available.
1 Week2 Weeks3 Weeks4 Weeks5 Weeks or more
Add any additional information here, such as if you have a preferred travel group or friend you would like to volunteer with.
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