Volunteer Provider Application materials

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