Volunteer Provider Application materials

Please submit the following to VCoordinator@aplacetobehealthy.org in one email:

• Completed Volunteer Provider application

  • ​Volunteer Provider Application (PDF)

    • This is a general application for all providers - MD, DO, PA-C, APRN, NP, PharmD, etc. Please only complete the sections that are relevant to your credentials.

  • Must include signed CEHC Policy Forms & a signed Education Verification Form

    • CEHC Policy Forms (PDF)

    • Education Verification Form (PDF)​

• 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​

    • More information: RI AG's website

  • ​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) OR

  • QuantiFERON blood test (for those who have received the TB vaccine, must be from within the last calendar year) OR

  • 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

    • Email: VCoordinator@aplacetobehealthy.org

    • Mail: ATTN: Volunteer Coordinator 60 Valley St., Suite 104 Providence, RI 02909​