Ben Massell Dental Clinic Volunteer Form

Thank you for your interest in volunteering for the Ben Massell Dental Clinic. Please fill out the form below, and we will be in touch with you shortly.

Pre-dental students: We are no longer accepting applications for the upcoming July-November 2024 period. Please check back in November to apply for the January-May 2025 volunteer cycle.

Contact Information

First Name*

Last Name*

Email*

example@example.com

Phone Number*

Area CodePhone Number

Volunteer Position*

DentistDental HygienistPre-dental Student (Waitlist for January-May 2025 cycle)

We are currently building a waitlist for pre-dental students for the January-May 2025 session. Can you commit to at least one weekly 4-hour shift during these months?*

YesNo

Dental Office

Specialty

How did you hear about volunteering with the Ben Massell Dental Clinic?*

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