myCovidMD

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Participant Registration

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Personal Information

First Name

Last Name

Email Address

Personal Information 2

What are your preferred pronouns?

What category(s) best describe you?

What religious family do you belong to or identify yourself most close to?

Address

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City

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Participant Information

Date of Birth

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Volunteer Registration

Fill in the fields at each step to complete your Registration

Message

Thank you for your interest in joining the myCovidMD® Volunteer Task Force.

You can become part of the movement to defeat the coronavirus pandemic worldwide that leaves no community behind.

In order to reach this ambitious goal, we need as much info about you so that we can best match your skill set with our growing list of needs in your desired location.

Please complete all of the questions.

Personal Information

First Name

Last Name

Email Address

Personal Information 2

What are your preferred pronouns?

What category(s) best describe you?

What religious family do you belong to or identify yourself most close to?

Address

Address line 1

Address line 2

City

State

Zip

Your COVID Story

What age range do you fall under?

Have you been tested for COVID-19?

Do you have a COVID-19 story? Please share your experience below:

Notifications and Skills

Would you like to opt-in to text notifications?
(Think upcoming events, special volunteer rewards, etc.)

Yes

What languages do you speak?

What is your profession? Do you have special talents/skills that we should be aware of?

interest Info

Please select any non clinical position(s) of interest. Leave empty if no preference.

What time option works best for you?

Service

What population group(s) would you like to serve?

What geographic location(s) would you like to serve?

Other

What type of Volunteer involvement are you looking for?

General Volunteer

TelePsych

TeleHealth

TeleWell

What Reward Type do you want?

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