Application Form

Thank you very much for your interest in serving at our Clinic.

In order to avoid many e-mails forth and back we ask you kindly to please respond briefly,
in English or in German, to the following questions.

Please send it to


Your profession:
Email address:
Date of birth:
Gender: male / female:
Are you a licensed professional in your country? 
From when to when are you available? 
Do you have alternative dates?
What is your Spanish ability? 
Would you come with spouse and/or children?
If yes, would they be willing to help in some capacity?
Do you have previous experience working in the developing world?
What is your motivation for working as a volunteer?
What expectations do you have for working in our clinic?
What do you think are the biggest challenges in working in another culture?
We accept volunteers of all religious denominations or beliefs. What do you think about Christian / Catholic values?
How did you hear about us?
If you are in the dental field: Would you be willing to join the German “Förderkreis Clinica Santa Maria e.V.”? For more information, please go to
Please email your completed application, along with your curriculum vitae (CV), current professional license (scanned copy), valid passport (scanned copy), documentation of specialty training (where applicable) and 3 references
Note: Surgical specialists are encouraged to recruit necessary support personnel, such as an anesthesiologist and OR nurse. Please ask them to complete the application process as well.
Please understand that the medications that we have chosen for our pharmacy are representative of those available in the Ecuador. We have selected them for affordability and when more costly but essential drugs are necessary we have chosen to subsidize them. Many of the medications commonly available to you in your home countries may not be able to be purchased in Ecuador or are prohibitively expense. It is important to utilize our formulary.
Similarly laboratory testing both those tests offered within the health center and particularly those from the commercial outside laboratory must be ordered judiciously so that limited resources for direct medical care are not diverted unnecessarily. Your generous donation of your time and skills will go much further in helping the Indigenous people of the Oriente if we all remain cognizant of the economic challenges faced by our patients.