Program Volunteer application

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Program Volunteer application form

PRIVATE AND CONFIDENTIAL

Counterpart is committed to protecting your privacy and the confidentiality and security of personal information provided by you to us. Consistent with the relevant privacy legislation, we ensure that your personal information will not be disclosed to others, except if required by law or other regulation.

Thank you for your interest in Counterpart and your willingness to apply to be part of our volunteer program.

To save your progress to continue later, please click on "Save and Continue Later", located at the bottom of the page.
Please indicate role you wish to apply for. (You may choose more than one):*
- Library volunteer (Tuesdays)
- Mail-out volunteer
- Any other way you wish to volunteer.
Please specify:
(For a description of these roles, please refer to our Volunteer information sheet).
Part 1 - Contact Details
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Phone Number*

Please enter the best number to contact you on during business hours.
Additional phone number
Email*
Would you like to be included on our mailing list?
- Yes
- No
- Already on
Part 2 - Personal Information
Answers to the following questions assist us to develop a volunteer group that comprises a diverse range of women.
Date of Birth*
DD slash MM slash YYYY
Country of Birth*
If not born in Australia, year of arrival
Do you identify as Aboriginal or Torres Strait Islander?*
- Yes
- No
- Prefer not to answer
2. Do you speak a language other than English?*
- Yes
- No
Please specify other languages spoken:*
Part 3 - General Information
1. How did you hear about Counterpart?*
2. What interests, experiences and skills can you offer Counterpart as a volunteer?*
3. Have you previously worked as a volunteer?
- Yes
- No
If yes, please tell us about it.
4. Why do you want to volunteer for Counterpart?*
5. What would you like to gain from volunteering with us?*
6. How much time would you be able to commit to volunteering at Counterpart?*
- One day per week
- One day per fortnight
- One day per month
7. Are you available to volunteer during the day on Tuesdays?*
- Yes
- No
8. Are you able to participate in a half-day of training at Counterpart in the city?*
- Yes
- No
9. Are there any current health issues that you feel we should be aware of?
10. My interest in breast and/or gynaecological cancer comes from:*
- Personal experience
- Partner's experience
- Family history
- Friend
- Other
If you would like, please provide details.
11. Is there any other information you would like to tell us about yourself?
12. Please provide the name, address and telephone number of a referee whom we can contact. This can be a relative, friend, work colleague or anyone else that you would be happy for us to speak to. Please explain his/her relationship to you.
Referee Name*
First Last
Preferred phone number*

Please provide the best phone or mobile number to contact your referee on during business hours.
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Relationship to you*
Thank you for providing the above information to us. If you have any queries or concerns, please contact Kellie Holland, Volunteer Coordinator on 03 8488 9834 or email [email protected]
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Comments
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Save and Continue Later

The Peer Support Volunteers understood my fears, the stress of navigating a cancer diagnosis and they are brilliant at answering questions and empathising.
Ashleen
I would never say I’ve walked in another’s shoes, but having walked a similar path means I can offer support that others aren’t always able to.
Greta, Peer Support Volunteer
It’s really useful to hear health professionals talk. I really appreciate them sharing their professional knowledge in an accessible way.
Maryam, webinar participant

Program Volunteer application form

Part 1 - Contact Details

Part 2 - Personal Information

Part 3 - General Information

CALL US 1300 781 500

Get in touch

Program Volunteer application form

Part 1 - Contact Details

Part 2 - Personal Information

Part 3 - General Information

Share this page

CALL US 1300 781 500

Get in touch