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Permission

When someone asks us to pass their information along to the Post Service Medical Unit at the Peace Corps, we need to know exactly what we should pass along. By filling out this form, you'll help us protect your privacy and make sure that only the information you want passed to Peace Corps goes there. Please copy this page, fill it out, paste it in and send it to us

Do you give permission for Health Justice for Peace Corps Volunteers to send this form to the Peace Corps' Post Service Medical Unit? (type "yes" here if you do) _______

What is the best way for the Peace Corps to contact you? (email, phone, address, etc) ____________________

Describe the problem you are having in a paragraph or two. The Peace Corps may ask for more, but this will give them an idea. ____________________

Thanks! We'll send this information on to the Peace Corps when we receive your response.


 

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