Health & Peer Support Volunteer

Peer supporters are women in the community who have shared experiences in common with the individuals they support.

Name

First Name

Last Name

Pronouns (she/her, they/them, he/him)

Date of Birth

Do you speak or write additional languages?

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Why do you want to be a health or peer support volunteer?

What is your experience supporting racialized women and communities?

Providing emotional support is both challenging and rewarding. What are you hoping to get out of this experience?

We expect volunteers to be reliable and punctual. How will you work this commitment into your other commitments and responsibilities?

Please include 2 references (name, number and relationship):

Emergency Contact Information (Name, Phone, Email, Address, Relationship to you)

Two professional references (i.e. supervisor, professor and coworker)

Name, Phone, Email, Relationship.