Volunteer RegistrationTell us where you are, what you do, and how you will support.This form helps Nexacare match applicants to field, data, community, learning, and programme opportunities based on location, skills, and programme needs. Please complete the highlighted fields before submitting your application. 1. Personal Information First Name *Middle NameSurname * Gender *SelectFemaleMale Date of Birth *Day12345678910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936Choose day, month, and year. Applicants must be 18 years and above. Age Range *Select18 to 2526 to 3536 to 4546 and aboveYour exact age will be calculated from your Date of Birth. Phone Number (WhatsApp Preferably) *Enter an active phone number. WhatsApp is preferred where available. Email Address *Confirm Email Address * 2. Location Information Country *Select CountryNigeriaGhanaKenyaOtherCountry Code State *LGA *Ward * Region or Province *City * Community or Settlement *Residential Address * 3. GPS and Current LocationAre you applying from the same ward, LGA, and state where you currently live? *SelectYesNoLocation access helps Nexacare match volunteers to nearby field activities. It is collected only with your consent.Capture My Current LocationWhere Are You Applying From?ReasonSelectSchoolWorkTemporary TravelRelocationOtherPlease Specify Reason 4. Education and Professional Background Highest Level of Education *SelectSecondary SchoolDiplomaONDHNDBachelor’s DegreeMaster’s DegreeClinical QualificationOther Institution Type *SelectSchool of Health TechnologySchool of NursingSchool of MidwiferyUniversityPolytechnicCollege of EducationOther Institution Name *Course or Discipline *SelectCommunity HealthNursingMidwiferyPublic HealthMedicineHealth Information ManagementMedical Laboratory SciencePharmacyEnvironmental HealthStatisticsData ScienceComputer ScienceSocial SciencesOther Professional Cadre *SelectCHEWJCHEWCHONurseMidwifeDoctorM&E OfficerData AssistantCommunity MobiliserHealth EducatorVolunteerStudentOther Academic Status *SelectCurrently in SchoolGraduatedAwaiting ResultInternship or Practical PlacementNYSCPostgraduate StudyProfessional TrainingNot ApplicableSelect the option that best describes your current academic or professional training stage. 5. Employment and Licence StatusDo You Have an Active Licence to Practise? *SelectYesNoNot applicableClinical or regulated roles require a valid professional licence where applicable.Professional Council or Licensing Body *SelectNursing and Midwifery Council of NigeriaCommunity Health Practitioners Registration Board of NigeriaMedical and Dental Council of NigeriaMedical Laboratory Science Council of NigeriaPharmacists Council of NigeriaHealth Records Officers Registration Board of NigeriaEnvironmental Health Council of NigeriaOtherLicence or Registration Number *Licence Expiry Date *Employment Status *SelectStudentCivil servantSelf-employedUnemployedNGO workerPrivate sector employeeHealth facility staffCommunity volunteerOtherBeing employed does not stop you from volunteering with Nexacare. This helps us understand your availability and avoid conflicts of interest.Current Employer or Agency *Job Title or Role *Department or UnitHow Many Hours Can You Spare Outside Your Working Hours? *Permission to Volunteer During Work PeriodsSelectYesNoNot applicable 6. IdentificationNIN Number *Check yours by dialing *346# on the mobile line you registered your NIN with.Means of ID Available *SelectNIN slipNational ID cardVoter cardDriver’s licenceInternational passportSelect the identification type you have available. Upload is not required at registration.ID Number * 7. Skills and Interest Areas Community mobilisation Household enumeration Health education Data collection KoboCollect ODK SurveyCTO DHIS2 Excel Power BI Routine immunisation Malaria MNCH Family planning Surveillance SBC Translation Training support Field supervision Digital tools support Safeguarding support Beneficiary feedback support 8. Volunteer MotivationWhy Do You Want to Volunteer With Nexacare? * 9. CV UploadUpload CV in PDF Format *Upload your CV in PDF format only. Maximum file size is 5 MB. 10. Consent and Declarations I confirm that all information provided is accurate and I understand that false information may lead to removal from the volunteer database. I consent to Nexacare storing my information for volunteer coordination, opportunity matching, training invitations, and field deployment planning. I consent to being contacted by email, phone, SMS, or WhatsApp. I understand that registration does not guarantee immediate deployment or payment. I agree to follow Nexacare’s safeguarding, confidentiality, and professional conduct requirements during any activity. I agree to disclose any conflict of interest before accepting any assignment. I consent to GPS collection where I choose to provide location access. I agree to receive updates, learning opportunities, and announcements from Nexacare. Submit Volunteer Registration