Application for Volunteer Dentist

Position at the Maasai Dental Clinic, LLC

Thank you for your interest in volunteering at the World Health Organization's Maasai Dental Clinic. Every
year, thousands of patients receive life-changing treatment at absolutely no cost thanks to incredible
individuals like you.

To apply, please send your completed application form and supporting documents (listed below) to
volunteer@worldhealthdental.org. Thank you again!

First Name* Nickname (opt) Last Name*

Syed Zohaib Ahmed

Phone* Email*

Address* City* State/Province* Postal Code* Country*

Emergency Contact* Relationship* Phone* Email*

Professional Reference #1 Phone Email

Professional Reference #2 Phone Email

What is the status of your dental license? Active - Practicing Active - Retired Expired

Please indicate any specialist qualifications you hold

Have you ever been named in a malpractice claim? If yes, please explain. Yes No

Have you ever had to pay or settle a malpractice claim. If yes, please explain. Yes No

Are you comfortable doing extractions?

If no, please explain. Yes No

How did you learn about the World Health Dental Organization or the Maasai Dental Clinic?

Have you ever volunteered as a dentist elsewhere? If so, where and when?

What language(s) do you speak?

Supporting Documents

Current CV
Dental school diploma
Copy of your dental license
Signed Volunteer Release and Waiver of Liability form
Headshot
Letter of Recommendation (if you have fewer than 3 years of experience)