Volunteer physicians, nurses, pharmacists, and others are needed to give four hours once a month. If you are interested, please print and complete the application form below, and mail it with required documents to the address on the form.

Cabrini Clinic of Most Holy Trinity Church
1050 Porter Street
Detroit, MI 48226-2405
(313) 961-7863 Fax (313) 965-9891


Volunteer Application Form


Date:_________________________________ Name: _______________________________________________________

Home Address: ______________________________________________________________________________________

__________________________________________________________________________________________________

Home Phone: (____)_______________ Work Phone: (____)_______________
Cell Phone: (____)_______________
eMail Address:_________________________

Current Employer: ____________________________________________________________________________________

Job Title: ___________________________________________________________________________________________

Area of Specialty/Credentials: ____________________________________________________________________________

Capacity in Which You Would Like To Volunteer: ______________________________________________________________

__________________________________________________________________________________________________

I am available to volunteer for the following shifts:

5 to 8 p.m. on the __1st __2nd __3rd __4th Tuesday evening of the month.

1 to 5:30 p.m. on the __1st __2nd __3rd __4th Thursday afternoon of the month.

5 to 8 p.m. on the__1st __2nd __3rd __4th Thursday evening of the month.

I would like to begin volunteering in the month of ____________________________

Other relevant information: ____________________________________________________________

___________________________________________________________________________________.

Please attach a copy of:
Your current professional license
DEA Number
Professional Liability Insurance Coverage (if applicable)
Your resume

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