COVID-19 Volunteer Request – Tri-County Health Network

Please submit the following form if your organization located in San Miguel or Ouray County is seeking volunteers to help during this COVID-19 crisis.

Organizational Information

Organization Name*

Primary Phone*

Primary Email*

Volunteer Dates, Times, Numbers, and Work Descriptions

Please provide the info below. If there are different shifts needed or different work requiring different volunteers to be done please complete 1 line item per shift/duty.

Date Range
(e.g. 4/2-4/16)*

Time/Shift
(e.g. 8am-10am)*

# of Volunteers
Needed*

Description of Work
(e.g. Help people load car)*

Volunteer Skills and Criteria

Please list any specific skills/criteria for the volunteers? (e.g. data entry, must be able to lift 20 lbs, at least 16 yrs old, etc.)*

Location of Volunteer Work

Street Address

City

State

Zip Code

If an address is not applicable, please specify the location here:

Supervisor Information

Supervisor Full Name (for the volunteers to check in with)*

Supervisor Cell Phone*

Supervisor Email*

If you get a message that says, "There was an error trying to send your message. Please try again later," just click "Submit" again.

If you continue to get an error message, please contact 970.708.7096 M-F 8 -5 for assistance.