Survivor Support Programme
Volunteer Application Form

Thank you very much for your interest!
Please complete and submit this form.

CONFIDENTIAL

First Name
Last Name
Street Address
City
Postal Code
Nearest Intersection
Home Telephone No.
Home Fax No.
Bus. Telephone No.
Bus. Fax No.
Email Address
Best time to reach you
Emergency contact
Languages Spoken

Do you have access to a car that you would be willing to use in your volunteering?

Yes No

How did you find out about the Survivor Support Programme?

Why are you interested in the Survivor Support Programme?

What do you hope to gain from this experience?

What are you currently doing? (work, school, etc.)

Do you have past volunteer experience? If so, where? doing what? and for how long?

How will you manage the time committment required (see job description)?

Please list any courses, workshops, degrees, training, etc. that you have?

Please describe any losses you have experienced - whether from death or separation, whether temporary or permanent. Please indicate how long ago?

References

Please provide 2 references. At least one should be work/volunteer related. By providing this information you are giving us permission to contact your references to discuss your involvement in the program.

1.	Name:
	Telephone:
	Relationship:

2.	Name:
	Telephone:
	Relationship:

Distress Lines are open 24 hours, 7 days a week 416-408-HELP (4357)

Survivor Support Programme Volunteer Application Form

References

Survivor Support Programme
Volunteer Application Form