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:
 Zip Code:
Home Telephone:
Work Telephone:
Other Telephone (cell):
Email Address:
Place of Employment:

Not applicable:

I would like to volunteer for the following
Medical Professional

List your specialty:


List your credentials:

Support Staff (such as secretarial duties,
telephone answering, data compiling)

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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