Get Involved

Medical Missions

Medical

  • Plastic Surgeon (with cleft experience)
  • Anesthesiologist (with pediatric experience)
  • Certified Registered Nurse Anesthetist (with pediatric experience)
  • Pediatrician (with current PALS)
  • OR Nurse
  • PACU nurse (with current PALS & ACLS)
  • Dentist
  • Dental Hygienist
  • Speech Pathologist (with cleft experience)

Non-Medical

  • Mission Director
  • Quartermaster
  • Sterilizer
  • Photographer
  • Medical Record Keeper
  • Family/Ward Coordinator
  • Translators

If you would like to volunteer in the office, please contact us for more information.

Get Involved

Volunteer Application Forms

Medical Volunteer Application

Please fill out our online application below. Or download the PDF version here.

Your Specialty (required)

The following documents should be submitted with your application. You will have a chance to upload them at the end of the application, or you can submit them separately via email, fax or standard mail.

  • Current License to Practice
  • Curriculum Vitae
  • PALS Certification (for Pediatricians and PACU Nurses)
  • Diploma
  • Board Certification (for Surgeons, Anesthesiologists, CRNAs and Pediatricians)
  • Cover Letter (Surgeons: include cleft experience; Anesthesiologists: include pediatric experience; PACU Nurses: include pediatric experience)
  • Photocopy of Passport
  • Attestation Form - can be downloaded here: Attestation Form
  • Please Note: If you are selected to volunteer on a mission, we will need a headshot of you. You may also submit that now.

Applicant Name


Applicant Address


Personal Information

Birth Date (required)

Gender

Passport Name
Complete Name as Shown on Passport

Passport Number

Passport Expiry

Nationality


Practice Information

Area of Specialty

Office or Hospital Name (if applicable)

Office or Hospital Phone


Travel Info and Trip Fees

Alliance for Smiles will cover international travel costs for medical volunteers. Each volunteer is required provide their own transportation to and from the US point of exit (usually San Francisco or Atlanta).

Approved mission volunteers are required to pay a $380 Mission Participation Contribution once they have been selected for a mission.

If you agree to above, please click Yes


General Information

Do you speak any languages besides English? (Indicate level of fluency)

Prior Medical Missions You Have Gone On (if any)

Are You A Member of Rotary? (Indicate club name/district and how long.)

Do you have any medical conditions we should be aware of?

Shirt Size (in unisex size)


Professional References

Please list two professional references - preferably physicians, dentist or allied health practitioners who are familiar with your work. If possible, include at least one member from the medical staff of each facility at which you have privileges.


Reference One

Full Name of Reference

Title

Phone

Email

Notes


Reference Two

Full Name of Reference

Title

Phone

Email

Notes


Documentation

The following documents must be submitted before you can be approved:

  • Current License to Practice
  • Curriculum Vitae
  • Diploma
  • Board Certification (only for Surgeons, Anesthesiologists, CRNAs and Pediatricians)
  • PALS Certification (only for Pediatricians and PACU Nurses)
  • Cover Letter (Surgeons: include cleft experience; Anesthesiologists: include pediatric experience; PACU Nurses: include pediatric experience)
  • Photocopy of Passport
  • Attestation Form - the form can be downloaded here: Attestation Form

If you don't have all the required documents currently with you, you can submit the application now and send the forms separately via email, fax or standard mail. You will find mailing address on the contact page.

To upload the documentation now, please upload below.

Upload files by clicking the Choose Files button.(You can upload several files, limit 5). You may also upload all documents together in one Zip file. Accepted formats: .doc, .docx, .pdf, .jpg, .zip. Size limit 5 MB.


Once you have completed the application and uploaded all files that you wish to, please agree to the terms and hit the Submit button below.

I fully understand that any significant misstatement in or omissions from this application will constitute cause for denial of my application for affiliation with Alliance for Smiles. I hereby affirm that the information I have furnished to Alliance for Smiles on this application and in any accompanying document is true and complete to the best of my knowledge.

Do you agree to the above terms?

Non-Medical Volunteer Application

Please fill out our online application below. Or download the PDF version here.

The following documents must be submitted before you can be approved. You will have a chance to upload them at the end of the application, or you can submit them separately via email, fax or standard mail.

  • Cover Letter and Resume (Please include how you heard about AfS, how you would like to volunteer for us, and your skills/qualifications.)
  • Photocopy of Passport
  • Please Note: If you are selected to volunteer on a mission, we will need a headshot of you. You may also submit that now.

Applicant Name


Applicant Address


Personal Information

Birth Date (required)

Gender

Passport Name
Complete Name as Shown on Passport

Passport Number

Passport Expiry

Nationality


Travel Info and Trip Fees

Volunteers will be required to pay their own travel expenses as specified by our travel agent. And each volunteer is required to pay a tax-deductible $380 Mission Participation Contribution once once they have been selected for a mission.

If you agree to above, please click Yes


General Information

Do you speak any languages besides English? (Indicate level of fluency)

Prior Medical Missions You Have Gone On (if any)

Are You A Member of Rotary? (Indicate club name/district and how long.)

Do you have any medical conditions we should be aware of?

Shirt Size (in unisex size)


Professional References

Please list a professional or personal reference who we may contact if necessary.


Reference One

Full Name of Reference

Title

Phone

Email

Notes


Reference Two

Full Name of Reference

Title

Phone

Email

Notes


Documentation

The following documents must be submitted before you can be approved:

  • Cover Letter and Resume (Please include how you heard about AfS, how you would like to volunteer for us, and your skills/qualifications.)
  • Photocopy of Passport

Note: If you are selected to volunteer on a mission, we will need a headshot of you. You may also submit that, if you like.

If you don't have all the required documents currently with you, you can submit the application now and send the forms separately via email, fax or standard mail. Mailing address and contact info are on the contact page.

To upload the documentation now, please upload below.


Upload files by clicking the Choose Files button.(You can upload several files, up to 5). You may also upload all documents together in one Zip file. Accepted formats: .doc, .docx, .pdf, .zip. Size limit 5 MB.


Once you have completed the application and uploaded all files that you wish to, please agree to the terms and hit the Submit button below.

I fully understand that any significant misstatement in or omissions from this application will constitute cause for denial of my application for affiliation with Alliance for Smiles. I hereby affirm that the information I have furnished to Alliance for Smiles on this application and in any accompanying document is true and complete to the best of my knowledge.

Do you agree to the above terms?

Get Involved

Our Volunteers

Volunteer Awards

Volunteer of the YearDistinguished Service AwardJohn Uth Memorial Award
2008 - Barbara Fisher2009 - Dr. Colin Wong2013 - Burton Berry
2009 - Dave Fowler2010 - Dr. Wally Chang2014 - Rotary Club of Wanchai
2010 - Wilber Breseman2011 - John Goings2015 - Rotary International
2011 - Dr. Quentin Li2012 - John Uth2016 - STOP Cleft International Alliance
2012 - Dr. Karin Vargervik2013 - Barbara Fisher
2013 - Tina Hollcroft2014 - Tina Hollcroft
2014 - Dr. Chih-Chen Fang
2015 - Mary Jensen
2016 - Dr. Billy De Shazo

Decade of Leadership Award

In order to celebrate dedication to AfS on the occasion of our 10th Anniversary, the Decade of Leadership Award was created to honor four remarkable individuals who have given of their skills and talents from the beginning days of Alliance for Smiles.

  • Barbara Fisher
  • John Goings
  • Dr. Karin Vargervik
  • Dr. Colin Wong

Legacy Club

In 2009 Alliance for Smiles launched its Legacy Campaign to encourage individuals to make a minimum $5000 one-time donation; or to make multiple donations through-out the year adding up to $5000. Participation in this campaign is recognized by membership in a special Legacy Club that will be publicized on the website, at the Gala and in literature. Everyone who donated a minimum $5000 by December 31, 2009 became a Charter Member of this very special Club.

Legacy Club Charter MembersLegacy Club 2010-2011
Burt BerryBurton Berry
Wilber BresemanWilber Breseman
Tai Can -WangTai Can-Wang
Dr. Wallace ChangCecile Chiquette
Cecile ChiquetteDavid De Roode
David De RoodeJim Deitz
James DeitzJohn Goings
John GoingsAllan Herzog
Allan HerzogSilvia Iselin
Bing Shin HoMary Jensen
Howard HoBenjamin Lam
Joe HoffmanDr. Quentin Li
Benjamin LamAnna Marie Marcias
Edward LauDr. Thomas Mack
Jojo and Noime LiangcoJames Patrick
Dr. Thomas MackAngelo Rebizzo
Gary MitchellDr. Collin Wong
James PatrickEdith Richter
Stacey QuoRobert and Kathryn Smith
Eng Rung TsaiJohn Uth
John UthDr. Karin Vargervik
Karin Vargervik
Dr. Colin Wong
Choi Chung Yuen

Individuals are inspired to volunteer and donate because of their belief in the work of an organization. Especially when considering humanitarian programs, the emotions felt because of participation in a program that changes lives can have a sincere and long lasting impact.

For many, what an individual accomplishes during his or her lifetime is totally satisfying and fulfilling. Involvement in family, friends and work create a sense of well being. However, for those who want to make a mark in another way and share more of their talents and wealth with humanitarian concerns, involvement in a cause can be extremely rewarding. When they pass, they will have left a humanitarian legacy.

Those people involved in the work of Alliance for Smiles, whether as volunteers or donors, are leaving a legacy that goes beyond the lives of the children receiving surgery. It extends to the patients’ families and to their villages. Alliance for Smiles heals tens of thousands of lives when considering the extended community affected.

To carry on the work of Alliance for Smiles, funding is crucial. Therefore, those individuals who are willing and able to make significant donations are core to program sustainability. These individuals have the opportunity to allow the work of Alliance for Smiles to progress, building on an impressive past.

Therefore in 2009 Alliance for Smiles launched its Legacy Campaign to encourage individuals to make a minimum $5000 one time or multiple time donation to the work of AfS. Participation in this campaign will be recognized by membership in a special Legacy Club that will be publicized on the website, at the Gala and in literature. Everyone who donated a minimum $5000 by December 31, 2009 became a Charter Member of this very special Club.

Our Founders

Alliance for Smiles was formally founded by five individuals: John Uth, John Goings, James Patrick, James Deitz and Anita Stangl. However, Alliance for Smiles wanted to recognize individuals who made a leap of faith in the concept of the work of Alliance for Smiles and decided to donate a minimum of $20,000 during the first four years of operation. They are also founders of Alliance for Smiles and will be recognized in perpetuity as such. The following individuals receive the honor of this unique position:

Mr. Burton BerryMrs. Debbie Jefkin-Elnakave
Mr. Bill BenterMr. Benjamin Lam
Mr. Wilber BresemanMrs. Noime Liangco
Dr. Wallace Chang, M.D.Dr. Thomas Mack, D.V.M.
Ms. Cecile ChiquetteMr. Donald Parachini
Dr. Scharleen Colant, Ph.D.Mr. James Patrick
Dr. James Deitz, Ph.D.Ms. Esther Rebizzo
Ms. Barbara FisherMs. Dee Dee Ricks
Mr. John GoingsDr. Alan Stormo, M.D.
Allan and Nancy HerzogMr. Eng-Rung Tsai
Mr. Howard HoMr. John Uth
The Family of TaipeiTai and Tony Wang (W.A.C. Lighting)
Mr. Joseph HoffmanDr. Colin and Mrs. Silvana Wong

Rotary Clubs who supported the work of Alliance for Smiles during its first four formative years with donations of $25,000 or more received the honor of being Founding Rotary Clubs. Alliance for Smiles recognizes three Rotary Clubs with this title and they will be recognized in perpetuity for their faith in the work and dreams of Alliance for Smiles.

The Rotary Club of San Francisco

The Rotary Club of Chicago

The Rotary Club of Wanchai, Hong Kong

Alliance for Smiles wishes to thank the above individuals and Rotary Clubs for their support which has helped Alliance for Smiles to not only facilitate medical missions during its first four years but to prosper and grow.

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