Volunteer Programs Form : Get Involved : Range of Motion Project

ROMP 2023 Volunteer Programs

Please complete this form to apply to volunteer in a ROMP 2023 Volunteer Program. Once you have submitted your application, we will review it and let you know if you have been selected. You can pay your fee in full via check or card. If you would like to fundraise your fee, we will send you a link to a Classy profile where you can make the deposit of $100 in order to formally enroll in the program and begin fundraising. If you have any questions, please direct them to volunteerprograms@rompglobal.org.

Which program do you plan to attend?

10-19 February 2023 in Guatemala
24 March-2 April 2023 in Ecuador
14-23 April 2023 in Guatemala
19-28 May 2023 in Ecuador (ONLY COLORADO STATE UNIVERSITY)
7-16 July 2023 in Ecuador
21-30 July 2023 in Guatemala
2-10 September 2023 in Ecuador (ONLY LOMA LINDA UNIVERSITY)
13-22 October 2023 in Guatemala
10-19 November 2023 in Ecuador

Name

First Name *

Last Name *

Gender

Female
Male
Prefer not to say

Mailing Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Primary Phone Number

Alternative Phone Number

Email Address

Do you have/will you have a passport that will be valid during the program you selected?

What is your profession or current training program?

Prosthetics and Orthotics
Physical Therapy
Occupational Therapy
Physical Medicine and Rehabilitation
Public Health
Social Work
Engineering, Design, Innovation

Other

How did you find out about ROMP Volunteer Programs? (Check all that apply.)

Through my academic institution or training program.
Through a ROMP email or social media.
Through a professional conference or publication.
I have volunteered with ROMP before.
Through my place of work.
Through my participation in the ROMP Components for a Cause Program.
Through my participation in the ROMP US Assistance Program.
Through my participation in Climbing or Moving for ROMP.

Other

If you are currently working, what is your employer and job title?

If you are currently working, how many years of experience do you have?

Please describe any prior international volunteer experience you have.

Please describe any professional specialties or special skills you have.

Please list any languages other than English that you speak, and your level of proficiency in each language.

T-Shirt Size

Dietary Preference/Allergies

Vegetarian
Vegan
Kosher
Halal
Gluten-free
None

Other

Full name of emergency contact

First Name *

Last Name *

Relationship with emergency contact

Address of emergency contact

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

Primary phone number of emergency contact

Alternative phone number of emergency contact

Please read the Volunteer Waiver, and digitally sign in the space that follows using your full name. Please note that your digital signature constitutes your true signature.