Expression of Interest Form

Expression of interest form

Register your interest in becoming a Counterpart Peer Support Volunteer, by providing some information about yourself and your volunteering exerience.

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.

Have you ever been diagnosed with cancer?*

Yes

No

Thank you for your interest, but you are not eligible to become a Peer Support Volunteer. Our volunteers need to have a lived experience of cancer in order to provide the support that they do.

Other ways you can support us

Donate

Support us to support you or the women you know and care about.

Fundraise

If you have an idea for a fund raiser we can help make it happen.

In memory

Remember Counterpart in your will, or making a donation in memory of a loved one.

Corporate engagement

Find out how businesses can support us to support Victorian women with cancer.

Have another idea?

If you would like to help us in some other way, please contact us.

Name*

Please enter your preferred name and family name/surname.

Preferred pronouns

E.g. she/her, they/them

Email address*

Phone number*

Please enter the best number to contact you on during business hours.

Suburb/town and postcode*

About you

What type of cancer/s have you been diagnosed with?

What month and year were you diagnosed?

How did you hear about the Counterpart Peer Support Volunteer program?*

Is there anything else you would like to tell us about yourself?

Checklist

Please make sure that you have read the Counterpart Peer Support Volunteer position description for more information about the role.

Please confirm the following before you submit this form:*

I understand that most training is online, but attendance at an induction day in the Counterpart Resource Centre, located in the CBD, is compulsory.

I understand that volunteer shifts are during the day on Mondays, Wednesdays and Thursdays, and I am generally available to volunteer on at least one of these days.

I understand that if I am accepted, I will need to attend on-the-job training in the Resource Centre, unless circumstances (such as distance) don’t allow this.

If I need to complete my on-the-job training online, or intend to volunteer from home, I will need access to a computer, a private space to work from, and a phone or mobile.

I can commit to volunteering for at least one year.

Comments

This field is for validation purposes and should be left unchanged.

[email protected]

[email protected]