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Health Ministries Association is continuing to expand its programs.  These ministries create opportunities for involvement in aspects of health where you may be passionate.  Please take 3 minutes to provide us with a little more information about yourself.  HMA will be better able to connect you to avenues of service and ministry that excite you.  Your response will help us tremendously.

  Required Fields

To:

Health@HMACofChrist.org

Name:

Address:

 

City:

State or Province:

ZIP:

Country:

Phone:

Additional Phone:

E-Mail:

Occupation:

Current Position:

Professional Designation/
Certifications
:

I give permission for my contact information to be shared with other members of HMA:

Yes

No

Please Send The HMA "Newsletter" By E-Mail

  Eco Friendly


Questionnaire:

Health Teams

Would you like to participate in a medical mission or health team to Central America?

Yes

No

If yes, in what capacity?

When might you be available?

Have you had previous experience on an international health team?

Yes

No

Do you have contacts for obtaining supplies and/or medications?

Yes

No

Do you know Spanish?

Yes, Some

Yes, Fluent

No

What other language(s) do you know?

Student Mentoring

Are you interested in working with or mentoring students?

Yes

No

If yes, how would you prefer contact with the student?

E-Mail

Phone

In Person

Would you like to provide a college student health care, job shadowing, or internship experience?

Yes

No

If yes, how long would you consider having them involved?

Day

Week

Month

Summer

Semester

Could you help chaperone a student health professional, Winter Term, or health team?

Yes

No

Association (Please indicate in which of the following activities you may be interested to help.)

Teach a health-related class

Yes

No

Conduct a workshop session

Yes

No

Write a health brief or newsletter article

Yes

No

Serve as a camp nurse

Yes

No

Serve as an congregational representative

Yes

No

Update website design and information

Yes

No

Post/send out HMA social media communication

Yes

No

Other skills, talents, interests


Additional Information:

Please Click In The Box Below. This Will Prove That This Is Not E-Mail Spam.

   
             

E-Mail Sent Using This Form Will Be Delivered To:  Health@HMACofChrist.org
(If you need to send an attachment, copy this E-Mail address and paste it into your own E-Mail program)

 
Health Ministries Association  Community of Christ International Headquarters 1001 West Walnut  Independence
Community of Christ
Health Ministries Association
Community of Christ Affiliate
Donation Donation Donation Donation Donation

1001 West Walnut, Independence, Missouri 64050-3562  U.S.A.

800.825.2806 Ext. 1262

816.833.1000 Ext. 1262

FAX:  816.521.3084

Community of Christ Health Ministries Association is a 501(c)(3) non-profit health organization supported solely by donations and gifts made
directly to HMA. For written permission to use the HMA logo on your publication or website, please contact the office 816.833.1000 ext.1418.

Updated 10/23/05