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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 VCoordinator@aplacetobehealthy.org

Please submit the following to VCoordinator@aplacetobehealthy.org in one email:
  • Completed Volunteer Provider application
    • PDF
      • 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.
    • Must include a signed Education Verification Form
  • 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 
      • MMR
      • TDap
      • Hep B
      • Varicella
  • TB screening
    • PPD skin test​ (must be from within the last calendar year)
    • QuantiFERON blood test (for those who have received the TB vaccine, must be from within the last calendar year)
    • Proof of successful TB treatment, if past diagnosis of TB (letter from provider and negative chest x-ray from within the last 10 years)
  • 2 Letters of Recommendation
    • Can be emailed or mailed directly to the clinic from the recommender
  • CEHC Policy Forms
    • These will be emailed to you once the above documents have been completed and received by the Volunteer Coordinator & senior clinic staff.
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