IRCOM Volunteer Application

Please return via e-mail to or by fax to 204-943-4810, Attn: Rayne Graff.

Section I: Personal Information

Full Name: Click here to enter text.

First and Last

Address: Click here to enter text.

Street Address, City, Province, Postal Code

Primary Phone: Click here to enter text. Alternate Phone: Click here to enter text.

E-mail Address: Click here to enter text.

Birth Date: Click here to enter text.

Day, Month, Year

Emergency Contact: Click here to enter text.

Name, Phone Number

What is the best way to get in touch with you (email, phone, text, etc.): Click here to enter text.

Section II: About the Position

Which volunteer position(s) are you applying for (please refer to the position descriptions)?

☐Homework Tutor ☐NLI Classroom Assistant

☐Children’s Program Assistant ☐Childcare Assistant

☐Youth Program Assistant ☐ABP Classroom Assistant

☐Mentor ☐Other (including practicum student)

Do you speak any other languages? Click here to enter text.

Please describe any skills and experience you have that are relevant to the position.

Click here to enter text.

Do you have any other areas of interest that might be useful to IRCOM?

Click here to enter text.

Section III: Additional Information

Are you a student? ☐Yes ☐No

If so, where? Click here to enter text. What are you studying? Click here to enter text.

Do you work? ☐Yes ☐No

If yes, ☐Fulltime ☐Part-time

Where? Click here to enter text. Job title: Click here to enter text.

Section IV: Media Consent (Optional)

IRCOM frequently takes photos at events and programs. By signing below, you give permission for your photo to be used in IRCOM’s promotional material, including but not limited to: print materials, website, social media, annual report, etc., as well as other materials produced in cooperation with partner agencies for the purpose of representing IRCOM as well as promoting IRCOM’s mission, objectives, and values. Note that signing is optional.

I, (print name) , give the Immigrant and Refugee Community Organization of Manitoba Inc. permission to use my photo in promotional materials.

Signature Date

Section V: References

Please list two people IRCOM can contact as your references.

Reference 1: Click here to enter text.

Name, Phone Number, Relationship to Volunteer

Reference 2: Click here to enter text.

Name, Phone Number, Relationship to Volunteer

Thank you for your application to volunteer with IRCOM. An IRCOM staff will follow up with you as soon as possible.