Welcome to the Jackson County Health Department, Jackson County WV

Volunteer Application Form

Pursuant to the terms of the Code of West Virginia and a grant sponsored by the Centers for Disease Control, it is the role of the Jackson County Health Department to provide pharmaceutical services in the event of an emergency (biological, chemical, terrorist attack, or natural disaster). In order to provide these services to the 28,000 citizens of Jackson County, we need your help! If you would like to join our Health Emergency Activation Team, please complete the volunteer application. Someone will be in contact with you to provide training for the role you choose to play. Together we can make our community a healthy place to work and live.

Name/Organization:

Address:

Individual Contact Name:

Home Telephone:

Cellular Telephone:

Pager:

Area of Expertise (Note: Some positions require a medical degree.)

If Language Interpreter was chosen, please note language(s) spoken here:

By checking this box, I verify that the above information is correct and factual to the best of my knowledge.

Thank you for your submission. A Jackson County Health Department representative will contact you shortly.