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Myeloma Peer Support Volunteer at Wellspring Application Form

in partnership with Myeloma Canada

    Your Name (required)

    Your Email (required)

    Your Address (required)

    Your Telephone (required)

    Please confirm that you are 18 years of age or older

    Please let us know if you are a:

    If you selected Patient, please let us know the date of your diagnosis

    If you selected Patient, please let us know if you have had any of the following? Please check all that apply

    If you selected Caregiver, please let us know your relationship with the patient.

    Are you bereaved?

    If Yes, what was the year of your loss:

    Have you volunteered for other organizations? If so, please briefly describe your duties.

    Peer support training is provided by Wellspring. It is an online, comprehensive training program to help support you in your peer support role. The training is approximately 12-15 hours over a series of weeks. Please indicate your preferred training time.

    Do you have any special skills, training or experiences that would be helpful as a Wellspring volunteer?

    We recognize that people who volunteer their time do so for specific reasons. What do you hope to develop or gain through your volunteer experience at Wellspring?

    Please provide us with the names and contact information for two professional or other volunteer placement references.

    Please Note: Successful candidates will be required to provide a "Canadian Police Information Computer Centre (CPIC) system record clearance (vulnerable sector clearance). Wellspring will provide you with information on how to obtain this. A cost to the police service for the application may apply.

    This Peer Support opportunity is available through the Wellspring Cancer Support Foundation, in collaboration with Myeloma Canada. It does not replace any other volunteer role or activity you may already have offered, and you may be contacted by either organization with respect to the interests you have expressed.

    After submitting your application, a Wellspring staff member will be in touch within a week.

    Thank you. You can expect to hear from Wellspring within a week of submitting this information. Thank you.

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