Application Form Application Form Please complete all sections of this form. This form will remain in Prairie Hospice confidential files. Prairie Hospice Society reserves the right to accept only those volunteers deemed to be best qualified for client service work. Personal InformationName(Required)Address(Required) Street Address City Province ZIP / Postal Code Phone(Required)PrimaryEmail(Required) How did you hear about us?(Required)How do you prefer to be addressed (preferred pronouns)?(Required) He/Him She/Her They/Them Communication skillsStrong English language fluency is essential for this role, as clear communication with both our clients and our team is critical to providing end of life care. Please rate your English proficiency. English speaking proficiency(Required) Fluent Advanced Intermediate Basic English writing proficiency(Required) Fluent Advanced Intermediate Basic What other languages are you fluent in?Comfort Level with TechnologyWe utilize email, online messaging and an online calendar. How comfortable are you with using technology such as email and our online VolunteerPortal?(Required) Very Comfortable Comfortable Uncomfortable Very Uncomfortable Other InformationWhat motivated you to volunteer with us?(Required)What do you hope to gain by volunteering?(Required)Have you experienced the loss of someone close to you or spent time with someone very ill or dying? If yes, how long ago?(Required)Work or Volunteer ExperienceWhat is your main field of work, study, or interest?(Required)Have you had volunteer experience?(Required)Committing time to Prairie Hospice SocietyOur volunteers are integral to the success of our programs and the well-being of our clients. By committing approximately 4 hours per week, you’ll not only be supporting our organization but also ensuring that the individuals and families who rely on us receive consistent care and companionship. Scheduling is flexible and self-directed, but we ask for at least a one-year commitment to build meaningful and dependable relationships with our clients. Are you willing and able to commit to this level of volunteering?(Required) Yes No Mandatory TrainingTo prepare you for this rewarding role, we offer a comprehensive training program. This includes a combination of in-person and virtual sessions. Attendance is required to ensure all volunteers feel confident and capable in their roles.Are you able to attend the mandatory training program? (approx. 20 hours)(Required) Yes No ReferencesPersonal References: (Friend, Volunteer or Work related) These individuals must be over 20 years of age, should have known you for more than 2 years and may not be a partner, spouse, family member or your therapist/counselor.Reference #1NameRelationshipPhoneEmail Best time to reachReference #2NameRelationshipPhoneEmail Best time to reachEmergency contactNamePhone numberRelationshipSign and submitSignature(Required)Date(Required) MM slash DD slash YYYY CAPTCHA
