Volunteer Access Volunteer Inquiry Form

Mental Health Visiting and Activity Volunteer Inquiry Form

Dear Volunteer Applicant,

Thank you for your interest in volunteering with Volunteer Access Mental Health Visiting and Activity Program. Volunteering in health care is a privilege and serious commitment.

Please complete the following questions. Once we have received your inquiry survey, you will be considered for an interview where you will be asked to complete a full application and assessment process.

These requirements to volunteer support excellent health and care for clients in an Island Health location and provide you with the a good foundation for volunteering in health care.

We appreciate you taking the time to consider whether volunteering with Volunteer Access Mental Health Visiting and Activity Program is the right choice for you.

Sincerely,

Mary Ann Snowden

Volunteer Access Program Coordinators

Question Title

* 1. Please share your contact information:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* 2. Are you able to commit to at least 60 hours or six months of volunteering?

Yes

Question Title

* 3. Please complete the following questions:

	Yes	No	N/A
The intake process takes six to eight weeks. Do you wish to continue with your application?	The intake process takes six to eight weeks. Do you wish to continue with your application? Yes	The intake process takes six to eight weeks. Do you wish to continue with your application? No	The intake process takes six to eight weeks. Do you wish to continue with your application? N/A
Are you available for a 2 to 4 hour volunteer assignment on a weekly or regular basis? 1-to-1 placements require longer than a 6-month commitment.	Are you available for a 2 to 4 hour volunteer assignment on a weekly or regular basis? 1-to-1 placements require longer than a 6-month commitment. Yes	Are you available for a 2 to 4 hour volunteer assignment on a weekly or regular basis? 1-to-1 placements require longer than a 6-month commitment. No	Are you available for a 2 to 4 hour volunteer assignment on a weekly or regular basis? 1-to-1 placements require longer than a 6-month commitment. N/A
Are you willing to attend an interview with the Access Program Coordinator?	Are you willing to attend an interview with the Access Program Coordinator? Yes	Are you willing to attend an interview with the Access Program Coordinator? No	Are you willing to attend an interview with the Access Program Coordinator? N/A
Are you willing to submit 2 personal references from non family members?	Are you willing to submit 2 personal references from non family members? Yes	Are you willing to submit 2 personal references from non family members? No	Are you willing to submit 2 personal references from non family members? N/A
Are you willing to complete a Criminal Record Check online?	Are you willing to complete a Criminal Record Check online? Yes	Are you willing to complete a Criminal Record Check online? No	Are you willing to complete a Criminal Record Check online? N/A
Can you complete eight hours of online training?	Can you complete eight hours of online training? Yes	Can you complete eight hours of online training? No	Can you complete eight hours of online training? N/A
Are you willing to complete additional site and assignment training?	Are you willing to complete additional site and assignment training? Yes	Are you willing to complete additional site and assignment training? No	Are you willing to complete additional site and assignment training? N/A
Do you have spoken English (ESL level 6 preferred)?	Do you have spoken English (ESL level 6 preferred)? Yes	Do you have spoken English (ESL level 6 preferred)? No	Do you have spoken English (ESL level 6 preferred)? N/A
If you are under the age of 16, do you understand that you will need your parent of guardian's consent to volunteer?	If you are under the age of 16, do you understand that you will need your parent of guardian's consent to volunteer? Yes	If you are under the age of 16, do you understand that you will need your parent of guardian's consent to volunteer? No	If you are under the age of 16, do you understand that you will need your parent of guardian's consent to volunteer? N/A
Island Health's Hygiene Policy requires that volunteers do not wear nail polish, long nails, artificial nails, extensions, nail jewelry, or hand/wrist jewelry. Plain bands are exempt. Do you understand and agree to follow the hygiene policy?	Island Health's Hygiene Policy requires that volunteers do not wear nail polish, long nails, artificial nails, extensions, nail jewelry, or hand/wrist jewelry. Plain bands are exempt. Do you understand and agree to follow the hygiene policy? Yes	Island Health's Hygiene Policy requires that volunteers do not wear nail polish, long nails, artificial nails, extensions, nail jewelry, or hand/wrist jewelry. Plain bands are exempt. Do you understand and agree to follow the hygiene policy? No	Island Health's Hygiene Policy requires that volunteers do not wear nail polish, long nails, artificial nails, extensions, nail jewelry, or hand/wrist jewelry. Plain bands are exempt. Do you understand and agree to follow the hygiene policy? N/A
Island Health's Influenza Policy requires that volunteers either have an annual flu vaccine OR wear a mask during each flu season between December to April. Do you understand and agree to follow the flu policy?	Island Health's Influenza Policy requires that volunteers either have an annual flu vaccine OR wear a mask during each flu season between December to April. Do you understand and agree to follow the flu policy? Yes	Island Health's Influenza Policy requires that volunteers either have an annual flu vaccine OR wear a mask during each flu season between December to April. Do you understand and agree to follow the flu policy? No	Island Health's Influenza Policy requires that volunteers either have an annual flu vaccine OR wear a mask during each flu season between December to April. Do you understand and agree to follow the flu policy? N/A
Are you willing to share your availability on the application form?	Are you willing to share your availability on the application form? Yes	Are you willing to share your availability on the application form? No	Are you willing to share your availability on the application form? N/A

Question Title

* 1. Please share your contact information:

Question Title

* 2. Are you able to commit to at least 60 hours or six months of volunteering?

Question Title

* 3. Please complete the following questions:

Question Title

* 4. Tell us a bit about yourself and why you feel this volunteer position is a good fit for you