Volunteer Interest Form

Thank you for your interest in volunteering with the Salt Lake County Health Department!

Volunteers play a role in our work in promoting healthy lives for our communities!

Please sign up below!

About You

First Name*

Last Name*

Preferred Name*

Mailing Address*

City & Zipcode*

Primary Language*

Additional Languages Spoken*

Date of Birth*

Email*

Phone Number*

Preferred Method of Contact*

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Areas of Interest to Volunteer For:

Select all that apply:

Medical Reserve Corps (MRC)

Community Health Fairs

Community Health Events

Other

Emergency Contact:

Name of Emergency Contact*

Phone Number of Emergency Contact*

Conflict of Interest Questions:

The following questions help us determine whether you need to file a conflict of interest disclosure form with the Salt Lake County Council. If you need to file, you will receive an email with the required form and instructions.

Do you receive compensation as a result of a current contract with Salt Lake County?*

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Are you an officer, director, agent, employee, or owner of a substantial interest in a business entity that is subject to the regulation of Salt Lake County or anticipates doing business with Salt Lake County?*

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Do you hold an investment, financial, or personal interest that creates a potential or actual conflict between your duties as a volunteer?*

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Send me a copy of my responses

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