Volunteers


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How Can I Volunteer?

Fill in the information below if you are interested in becoming a volunteer for the Department (and the community) during a disaster. By entering the information below, you are agreeing to allow your contact information to be given to any of our partnering agencies who generally coordinate volunteers. Thank you in advance for your time and efforts to become a volunteer.

Today's Date:

Your Full Name:

Allen County Resident?

If not, resident of what county:

Mailing Address:

House/Apt. Address:

City:

State:

Zip Code:

Home Telephone:

Work Telephone:

Other Telephone (cell):

Email Address:

Employed?:

Place of Employment:

Occupation:

Not applicable:

I would like to volunteer for the following areas:
	Medical Professional	List your specialty:
		List your credentials:
	Support Staff (such as secretarial duties, telephone answering, data compiling)
	Other	Please list skills:

I understand that by clicking the "Submit" button below, that my information will be electronically transferred to the staff of the Fort Wayne-Allen County Department of Health. I further understand that by clicking the "Submit" button below that I am agreeing to allow my contact information to be shared with other appropriate partnering agencies which coordinate and keep in contact with all community volunteers.

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This page was last updated: January 09, 2008

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