Interest Survey

Question Title

* 1. Are you an older adult or Loyalist student?

Older adult (55 years of age or older)

Loyalist student

Other (please specify)

Question Title

* 2. Are you interested in learning more about Home Share Loyalist?

Yes

Question Title

* 3. Please share your contact information

Name

Email Address

Phone Number

Question Title

* 4. The person completing this survey is: (please check one)

Applicant/self

Home Share Team Member

Community partner

Other

Question Title

* 5. If a community partner, organization name

Question Title

* 6. Other information that may be helpful for the home share team to know at this time

This information is collected by Loyalist College under the authority of Section 2 of the Ontario Colleges of Applied Arts and Technology Act for recruiting and related purposes. Information may be stored and processed by College service providers who reside in the United States. For more information, contact the Freedom of Information and Privacy Coordinator at fippa@loyalistcollege.com and 376 Wallbridge-Loyalist Road, Belleville ON, or review our Privacy Statement. Contact information will not be used for commercial purposes, only as it relates to the Home Share program.

Thank you for expressing an interest in this program!