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Volunteer Provider Application materials

Please see below for a complete list of materials needed for every Volunteer Provider application. If you have any questions, please email

Completed Volunteer Provider application
  • PDF
  • Word Doc
  • This is a general application for all providers - MD, DO, PA-C, APRN, NP, etc. Please only complete the sections that are relevant to your credentials.
Current Resume/CV
Copies of all current medical licenses and board certifications
  • All volunteer providers must be licensed to practice in Rhode Island
  • A complete list can be found in the Volunteer Provider Application
RI State BCI
  • Done at the Attorney General's Office
    • 4 Howard Ave., Cranston, RI
    • $5, cash not accepted​
  • BCIs from other states are not accepted
  • Federal background checks are not required
Immunization Records
Must include:
  • COVID-19 (must be up to date)​​
  • Flu (from this year's batch)
  • MMR
  • TDap
  • Hep B
  • Varicella
Negative PPD test from the last year
2 Letters of Recommendation
  • Can be emailed or mailed directly to the clinic from the recommender
  • Email:
  • Snail Mail60 Valley St., Suite 104 Providence, RI 02909​
CEHC Policy Forms
  • These will be emailed to you once the above documents have been completed and received by the Volunteer Coordinator
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