Last Aid Volunteer Facilitator Application Form - CHPCA

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Last Aid Volunteer Facilitator Application FormTara Landry2024-10-29T18:30:26-04:00

Last Aid Volunteer Facilitator Application Form

Step 1 of 3

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Background Information

Your Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Province Postal Code

Main Telephone Number

Your Email Address(Required)

Age Group(Required)

18-24

25-34

35-55

55+

Gender

Pronouns

Are you currently:(Required)

Employed

Retired

Student

Other

LinkedIn Profile link (if you have one)

Volunteer Role

What Last Aid facilitator position are you applying to?(Required)

Clinical Facilitator

Allied Health Professional/Lived Experience Facilitator

Both

Last Aid workshops require two facilitators: one Clinical Facilitator and one Lived Experience Facilitator. Do you have a friend or a colleague you would like to apply with?(Required)

Yes

No

If you answered yes to the previous question, please provide the first and last name of the person you are applying with.

Are you interested in:(Required)

In-person facilitation

Online facilitation

Both

Volunteering Interest / Motivation

How did you hear about the Last Aid program?(Required)

I took a course

CHPCA website

Word of mouth

Social media

CHPCA newsletter

Volunteer work at local hospice

Provincial Hospice Palliative Care Associations

Other

Why are you interested in facilitating the Last Aid course?(Required)

Have you had experience with death and dying, hospice palliative care, caregiving, etc.? Please note, we do ask that those who have had a close family member, friend etc., recently die to wait a year before volunteering with the Last Aid Program.(Required)

Yes

No

If you answered "yes" to the previous question, please specify.

What do you hope to gain from your volunteer experience with the Last Aid Program?(Required)

Do you have any physical or medical restrictions/conditions that we should know about/that you will require accommodations for?

Please provide any other information you would like to share.

Work Experience and Education

Please describe your education, skills and abilities that will be beneficial to the Last Aid program.(Required)

What languages do you speak, write, or read?(Required)

English

French

Both

Other

What do you feel are your greatest strengths as it relates to the facilitator role?(Required)

Availability

Please check the days and times you are available to volunteer:(Required)

Monday Mornings

Monday Afternoons

Monday Evenings

Tuesday Mornings

Tuesday Afternoons

Tuesday Evenings

Wednesday Mornings

Wednesday Afternoons

Wednesday Evenings

Thursday Mornings

Thursday Afternoons

Thursday Evenings

Friday Mornings

Friday Afternoons

Friday Evenings

Saturday Mornings

Saturday Afternoons

Saturday Evenings

Sunday Mornings

Sunday Afternoons

Sunday Evenings

Time Commitment

Training consists of the Last Aid’s facilitator training (completed online, approximately a half-day). Can you commit to a half-day of training?(Required)

Yes

No

Can you commit to facilitating a minimum of 2 sessions per year?(Required)

Yes

No

Can you commit to volunteering with the Last Aid program for at least 1 year?(Required)

Yes

No

Volunteer Agreement(Required)

I understand that not all applications will be accepted.

Upload Your Resume(Required)

Upload your resume in .pdf format please

Accepted file types: pdf, Max. file size: 50 MB.

Mailing Address

Canadian Hospice Palliative Care Association
M332 – 1554 Carling Avenue
Ottawa, ON, K1Z 7M4

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