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Midland Health & Senior Services Volunteer Application

  1. This information used to determine what size Personal Protective Equipment (PPE) to issue, if required.

  2. This information used to determine what size Personal Protective Equipment (PPE) to issue, if required.

  3. Please list any languages you speak or write, including sign language

  4. Please list any skills, experience or abilities that could be of service to the community

  5. Please list applicable professional licenses and / or certifications

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  7. This field is not part of the form submission.