top of page
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 VCoordinator@aplacetobehealthy.org
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: VCoordinator@aplacetobehealthy.org
-
Snail Mail: 60 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
bottom of page