WIC Program Volunteer Application

Thank you for your interest in volunteering with Harris County Public Health (HCPH)! Volunteers are allowed to participate in both office and community-based projects. While clerical opportunities are often available, please let us know if you have a special skill or interest because we may be able to design an opportunity especially for you! You are encouraged to visit our website at www.hcphtx.org to learn more about the five Divisions and four major Offices that make up HCPH. The HCPH Main Office is located at 2223 West Loop South (in the Galleria area), but we have several locations throughout Harris County.

New User Details

User ID

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Password

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WIC Program Volunteer Application

* First Name

MI

* Last Name

* Home Address

* City

* State

* Zip Code

* Home Phone

* Mobile phone that accepts text messages

* E-mail Address

Additional languages

Highest Education Level Achieved

Are are you at least 18 years old?

* DOB

Do you have personal transportation?

Are you applying to Volunteer/Intern on a Visa?

If so, which one?

Please check all skills that apply to you

* Types of Previous Paid Experience:

* Types of Previous Volunteer Experience:

Have you ever been convited of an offense? (Exclude minor traffic violations)

If yes, please explain:

Please upload a copy of your resume:

Volunteer Preferences

Visit our website at http://publichealth.harriscountytx.gov/Services-Programs/Services/WIC to read more about our Women, Infants and Children (WIC) Program. Please note that the WIC program is within our Nutrition and Chronic Disease Prevention Division (NCDP).

Division/Office of Interest

Please select the opportunity you would like to volunteer with

Please select your preferred WIC location

Availability

* Available Starting Date

* Preferred Ending Date

Check the box of the days and times you are available.
Most of our offices are not open on the weekends/evenings.

Monday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Tuesday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m.- 5 p.m.

After 5 p.m.

Wednesday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Thursday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Friday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Saturday

All Day

8 a.m. - 11 a.m.

11 a.m. - 2 p.m.

2 p.m. - 5 p.m.

After 5 p.m.

Personal Reference

List a reference who is NOT RELATED to you

Name

Phone Number

Emergency Contact

In the event of an emergency, whom should we contact?

* Contact name

* Relationship

* Home/Cell Phone

Alternative Phone

For Medical Professionals ONLY

Type of License

Active License Number

Expiration Date

State

Person verifying license

Board Certification

Please Download and Review the Following Agreement Forms:

Individuals wishing to volunteer or intern at HCPH are required to provide an electronic signature demonstrating their willingness to adhere to the required statements, releases, and agreements of the Volunteer and Internship Program.
Please read each document by clicking the link next to the file name, and then type in your name in the electronic signature box.
By providing your electronic signature you are consenting to all of our agreement forms.

Confidentiality Statement

Please click here to download

Volunteer/Intern Code of Conduct

Please click here to download

Photography Consent Form/Model Release

Please click here to download

Release and Indemnification Agreement

Please click here to download

Volunteer/Intern Participation Agreement

Please click here to download

Volunteer/Intern Social Media Policy

Please click here to download

Vaccination Requirements

Please click here to download

Non Employee County Vehicle Policy

Please click here to download

Personal Vehicle Policy

Please click here to download

Volunteer Acknowledgement Waiver And Release

Please click here to download

Volunteer Standards of Conduct

Please click here to download

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Please sign your name in the electronic signature box below