Connect for Health Volunteer Application Form

Connect for Health Volunteer Application Form

Please fill out this form as completely as possible and email it to . If you have any questions, please ask!

1.  Name

First Name

Last Name

2.  Email Address

3.  Address*

Address 1

Address 2

City

State/Province

Postal Code

Phone

4.  Can we text you? (Yes/No)

5.  Are you 19 years or older? (Yes/No)

6.  Major/Degree and Educational Institution

7.  If you are currently a student, please select your year:*

First

Second

Third

Fourth

Fifth

Graduate

Unclassified

8.  Please describe any relevant education, work, or training experience. (maximum 200 words, point form is acceptable)

9.  What other commitments will you have during the next 9 months and how many hours/week do you anticipate devoting to them?

10. What times during the day Monday-Friday are you available to volunteer?

10 am - 2 pm

12 pm - 4 pm

1 pm - 5 pm

Other times between 9 am and 5 pm, Monday - Friday:

11. What draws you to volunteer with Pain BC’s Connect for Health service? What do you hope to gain personally from the experience? (maximum 200 words; point form is acceptable)

12. What skills or personal qualities do you possess that could be applicable to the role of a Connect for Health volunteer (see Role Description)? (maximum 200 words; point form is acceptable)

13. How have you demonstrated these skills and/or qualities? (maximum 200 words; point form is acceptable)

14. Describe a situation where you needed help/support. What did you learn from the situation? How might this experience affect your work with Connect for Health? (maximum 200 words; point form is acceptable)

15. Describe a time you worked with others to accomplish a task or project? What role did you take? What made that community effort or team work well or not work well? What role did you play in the success or in addressing the challenge? (maximum 200 words; point form is acceptable)

16. Describe a time when someone you worked with (or were close to) chose a plan of action with which you strongly disagreed. How did you handle the situation and/or the relationship? (maximum 200 words; point form is acceptable)

17. Many of us find certain topics, issues or personalities more difficult to be objective about than others. Please tell us about some that are challenging for you and how you deal with them. (maximum 200 words; point form is acceptable)

18. What else would you like to add that will give us a clearer picture of who you are? (maximum 200 words; point form is acceptable)

19. Do you want to volunteer with Connect for Health to gain more experience for admission to a graduate/professional program in the future? (Yes/No)

20. If yes, which program?

21. How did you hear about Connect for Health?