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RNRN Disaster Relief Volunteer Form

Be there for patient care...

Thank you for signing up with the RN Response Network (RNRN), a project of the California Nurses Foundation (CNF). RNRN is a national network of direct care RNs - powered by National Nurses United (NNU) - that coordinates sending volunteer RNs to disaster stricken areas where and when they are needed most. Registering as an RNRN volunteer does not automatically mean you will be called for a disaster. RNs will be asked to volunteer based on need and availability. PLEASE JOIN US TODAY!

Download & share the RNRN brochure

Please complete this form if you are interested in volunteering for RNRN relief deployments. If you have already signed up as a volunteer and would like to update the information you have already submitted you can log in here to access your information.

Thank you for volunteering with RNRN/NNU.
First name  
Last Name 
Address  
City  
State/Province  
Zip/Postal Code  
Home Phone  ( - 
Cell Phone ( - 
Primary Email  
Password:
(for updating your info later) 
Are you a Registered Nurse? 
Are you a Nurse Practitioner? 
RN License Number 
RN License Current?  
RN License Restrictions? 
Hospital/Facility or Affiliation & Location (example: Mountainview Hospital, UCLA Medical Center, or Not Working) 
What unit do you currently work in? 
Other Unit or Expertise? (For example Wound Care. HIV AIDS Clinic, or other units you have worked in extensively but are not your current unit.)
Please select all of the units you would feel comfortable working in: 
Job Title or Classification (Staff RN, Supervisor, etc.) 
When is the last time you worked in an acute care setting as an RN? 
Vaccinations/Tests: This is for information only, not requirements for volunteering. For most deployments, certain vaccines will be either recommended or required. RNRN cannot guarantee deployment, so we do not recommend getting vaccinations or tests before your deployment is confirmed. However, it is useful to gather proof of vaccinations and research how and where you can get any needed vaccinations and tests on short notice in your area. You do not need to take any action unless you are instructed by RNRN staff to do so for a confirmed deployment.
Current Hep A?
Current Hep B?
Current Typhoid?
Current Tetanus?
Current Influenza?
Current H1N1? (recommended, not required)
Current Meningococcal?
Current Measles, mumps, rubella (MMR)?
Curent Diphtheria/pertussis/tetanus (DPT)?
Current Poliovirus?
Current Varicella (Chickenpox)?
HIV test in last 12 months? (Required for Navy deployments)
TB test in last 12 months? (Required for Navy deployments)
Do you have up to date records of your immunizations?
Languages:
Do you speak French? 
Do you speak Spanish? 
Primary Language 
List other languages you speak: 
Current Specialties/Certifications:
ACLS 
PALS 
BLS 
CCRN 
PHN 
Other Specialties/Certifications
Other Experience & Travel:
Do you have disaster relief experience? 
If Yes, please list what/where:
Do you have a current passport? 
Passport Expiration Date 
Do you have a passport issued by the United States? 
If your passport is not issued by the United States, please list the issuing country:
Availability:
Length of Availability (We understand it may be different than length of release time you are ultimately approved for.) 
If chosen for deployment, you may be given very short notice (1 to 3 days) before the departure date. Is this something you can do?  
Deployment is not guaranteed, so it is important to have an ongoing conversation with your hospital regarding flexibility for release time. How long will your hospital/facility be able to approve release time on short notice?  
Additional availability notes:
Affiliations:
Are you a National Nurses United (NNU) member? 
Are you a California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) member? 
Thank you for completing the RNRN volunteer application. Please remember that volunteers are matched to deployments based on skill set, experience and availability. If you are not a match for current deployments, we may not be able to contact you directly but will update all volunteers as much as possible. Thank you again for volunteering with RNRN.