Research Volunteer Program Application

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Volunteer Registration

* First name

* Family/last name

Home address

* E-mail

* Line 1

Line 2

* Home phone

* City

Mobile

* Prov

Postal Code

Work phone

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Emergency Contact info:

* Contact name

* Relationship

* Home phone

Work phone

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For statistical purpose only, please indicate which age bracket you are in:

19-30

30-50

50 & Over

Birthday (optional)

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Background/Skills and Interests:

* Why are you interested in volunteering at CAMH?

What skills can you offer as a volunteer?

(use drop down to slect a single skill, or click "edit" to select multiple skills)

Skills

placement at CAMH:

* Please describe any previous experience you have that would be an assest to your volunteer

* What is your present occupation? If you are a student, please list field and year of study:

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Commitment and Availability:

Please check off your availability for volunteering.

Research volunteers must commit to one 8 hour shift per week.

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Monday 9-5

Tuesday 9-5pm

Wednesday 9-5pm

Thursday 9-5pm

Friday 9-5pm

Volunteers are required to make a one-year (renewable) commitment to the Centre for

Addiction and Mental Health. Are you able to make this commitment?

Yes

No

If accepted as a volunteer would you be interested in joining the on-call volunteer list to

assist with special events and emergency coverage?

Yes

No

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Ocassionally we have reqests for volunteers who speak another language. Please let us

know if you speak another language fluently:

Language

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References:

Please list two references who can be contacted

PLEASE DO NOT LIST ANY FRIENDS OR FAMILY

First Reference

* Name

* Phone

* E-mail

* Address 1

Address 2

* City

Postal Code

* Nature of Relationship:

Second Reference

* E-mail

* Name

* Phone

* Address 2

Address 1

* City

* Postal Code

* Nature of Relationship:

Please note that criminal reference checks may be required for volunteer placement